
LIBRARY OF CONGRESS. 



Cliap.„ Copyright No.,_. 

SheH__EuL5 U 



UNITED STATES OF AMERICA. 



SKIN DISEASES 



OF 



CHILDREN 



BY 



J 



GEORGE HENRY FOX, A.M , M.D. 

Clinical Professor of Diseases of the Skin, College of Physicians and Surgeons, 
New York ; Physician to the New York Skin and Cancer Hospital, etc. 



WITH TWELVE PHOTOGRAVURE AND CHROMOGRAPHIC PLATES, 
AND SIXTY ILLUSTRATIONS IN THE TEXT 




TWO COPIES RECEIVED 

NEW YORK g\ 5^) OH 

WILLIAM WOOD & COMPANY 

1897 




Copyright, by 
WILLIAM WOOD & COMPANY, 

1897. 



% 



n .^0 



^^.H 



PREFACE. 



A series of illustrated articles on certain skin diseases 
which are apt to occur in infancy and childhood appeared 
in the American Journal of Obstetrics and Diseases of 
Women and Children a year ago, and are now published 
in book form. While some additions have been made 
to most of them, the work is far from being a complete 
description of all the cutaneous affections which occur in 
childhood. It is merely intended to serve as a concise 
and practical sketch of the symptomatology and treat- 
ment of those eruptions which are most likely to affect 
the juvenile patients of every family physician. 

To Dr. Horace S. Stokes the thanks of the author are 
due for valuable assistance, especially in the compilation 
of the appended formulary. 

18 East 31st street, New York, 
June, 1897. 



CONTENTS. 











PAGK 


Alopecia Areata, ........ 1 


Ringworm and Favus, 










. 11 


Contagious Impetigo, 










. 21 


Psoriasis, .... 










. 27 


Ichthyosis, .... 










. 35 


Eczema, .... 










. 41 


Papilloma Lineare, 










. 51 


Naevi, Pigmented and Hairy, 










. 55 


Vascular Nsevus, 










. 61 


Lupus and other Tuberculides, 










. 67 


Lichen Ruber and Lichen Planus, 










. 75 


Syphilis Hereditaria, . 










. 83 


Erythema Nodosum, . 










. 84 


Purpura, .... 










. 85 


Molluscum, 










. 87 


Keratosis Follicularis, 










. 89 


Keloid, 










. 90 


Scabies, 










. 92 


Formulary, . . . 










. 95 


Index, .... 










. 161 



LIST OF ILLUSTRATIONS. 





PLATES 


• 








FACING 




PAGE. 


Alopecia areata, 


1 


Trichophytosis capitis, 












. 11 


Impetigo contagiosa, . 












. 21 


Psoriasis, 












. 27 


Ichthyosis, 












. 35 


Eczema, 












. 41 


Papilloma lineare, 












. 51 


Naevus pilosus, 












. 55 


Vascular naevus, 












. 61 


Lupus vulgaris, 












. 67 


Lichen ruber, 












. 75 


Syphilis hereditaria, . 












. 83 




FIGURES 











FIG. 

1. Bald ringworm, ..... 

2. Serpiginous form of alopecia areata, 

3. Alopecia areata — growth of white hair on patches 

4. Alopecia areata— complete loss of hair, 

5. Trichophytosis corporis, 

6. Favus corporis, 

7. Trichophytosis capitis, 

8. Trichophytosis disseminata, 

9. Favus capitis, 

10. Contagious impetigo, 

11. Confluent lesions of impetigo, 

12. Impetigo — umbilicated lesion on forehead 

13. Psoriasis— punctate lesions covered with white scales 



PAGE. 

2 

3 

4 

5 

12 

13 

14 

15 

16 

22 

23 

24 

28 



vm 



LIST OF ILLUSTRATIONS. 



Fig. 






PAGE. 


14. Psoriasis— guttate lesions with scales washed off, 


. 29 


15. Nummular and circinate psoriasis, . 


. 30 


16. Psoriasis— patches healing in centre, enlarging and coalescii 


ig, • 31 


17. Ichthyosis, . . . . . . . 


. 36 


18. Ichthyosis with broken epidermis, . 


. 37 


19. Ichthyosis with fine scales, . 


. 38 


2D. Polygonal plates of ichthyosis, . 


. 39 


21. Eczema squamosum, ...... 


. 42 


22. Eczema squamosum, ...... 


. 43 


23. Eczema rubrum, . . . . 


. 44 


24. Eczema impetiginosum, ..... 


. 45 


25. Eczema pustulosum, ...... 


. 46 


26. Linear papilloma, ... 


. 52 


27. Linear papilloma, ..... 


. 53 


28. Naevus, . . . . . . . 


. 56 


29. Naevus, . . . 


. 57 


30. Naevus, . . . 


. 58 


31. Nsevus of nose, . . . . . 


. 62 


32. Birthmark of unusual extent, .... 


. 63 


33. Naevus of scalp, ...... 


. 64 


34. Nsevus tuberosus, ...... 


. 65 


35. Naevus of vulva, ...... 


. 66 


36. Lupus vulgaris— a group of tubercles, 


. 67 


37. Lupus vulgaris — tubercles forming a ring,. 


. 68 


38. Serpiginous lupus with central cicatrix, 


. 69 


39. A favorite site of lupus, ..... 


. 70 


40. Lupus verrucosus (tuberculosis verrucosa cutis), 


. 71 


41. Ulcerating lupus with atrophy of bone, 


. 72 


42 Lupus erythematosus, ..... 


. 73 


43. Papular form of lichen ruber, 


. 75 


44. Lichen ruber — papules on a favorite site, 


. 76 


45. Plantar lichen ruber resembling eczema, 


. 76 


46. Lichen ruber resembling ichthyosis, 


. 77 


47. Lichen ruber resembling psoriasis, . 


. 77 


48. Rugous form of lichen ruber, .... 


. 78 


49. Lichen ruber — chronic form of disease, 


. 79 


50. Moniliform lichen ruber, . . . 


. 80 


51. Lichen planus, 




. 81 


52. Lichen planus, 






. 81 


53. Lichen planus, 






. 82 


54. Erythema nodosum, 






. 85 


55. Purpura, 






. 86 


56. Molluscum, 






; 88 


57. Keratosis follicularis, 






. 90 


58. Keloid, 




• . • 


. 91 


59. Scabies, 




. . • 


. 93 


60. Pustules in scabies. 




. 


. 94 



I 1 1, ATE I 





ALOPECIA AREATA. 
From the collection of photographs of 
Dr. GEORGE HENRY FOX. 



ALOPECIA AREATA. 



Alopecia areata is an affection of frequent occurrence in 
childhood, and one which the family physician should be com- 
petent to recognize and to treat. . To say that he should be able 
to treat a case as successfully as any specialist is not making a 
great claim, when we consider how little positive knowledge is 
possessed by the latter concerning the cause and cure of this not 
uncommon disease . 

As the name indicates, alopecia areata implies the occurrence 
of baldness in spots; but all bald areas are not necessarily cases 
of alopecia areata. Before describing the affection itself it may 
be well to refer briefly to certain forms of baldness, areate or 
complete, which are often improperly classed as cases of the 
disease in question. 

When infants are born without hair, and for years, perhaps, 
exhibit but a sparse capillary growth, coincident usually with 
imperfect dental development, this condition is not to be re- 
garded as alopecia areata and the term is not apt to be applied. 

When, as a result of injury, fright, or intense mental excite- 
ment, the hair falls suddenly from the scalp, or from the whole 
body in the case of adults, we have a condition which is by no 
means one of true alopecia areata, although in such cases the 
name is very apt to be misapplied. 

When, from injury to a nerve, an irregular patch of baldness 
develops upon the portion of hairy skin which the nerve sup- 
plies, the condition is one which strongly resembles the disease 
in question . It differs, however, from true alopecia areata in 
several essential points. It usually lacks the rounded outlines, 
it does not tend to spread or duplicate itself at other points, and 
the hairs at the margin of the bald area are not loosened. It is 
a bald patch of evident neurotic origin, but should be distin- 
guished from alopecia areata. 

A rare form of scalp disease, known as folliculitis decalvans, 



2 SKIN DISEASES OF CHILDREN. 

occurs in children as well as in adults, and is very apt to be 
mistaken for the commoner disease, to which it may bear a 
strong resemblance. Its distinguishing features are the signs 
of inflammation in incipient patches, the groups of dark plugged 
follicles, and the atrophied or cicatrized appearance of the bald 
patches, which are usually numerous and small. In very rare 
cases of ringworm of the scalp a smooth, bald patch results 
(Fig. 1). Whether this is to be regarded as a peculiar form of 
ringworm (so-called bald ringworm), or as a case of alopecia 




Fro. 1.— Bald ringworm. 

areata developing on the site of trichophytosis, is a vexed 
question. 

In true alopecia areata we have as essential clinical features 
the development of the disease in one or more small, rounded 
patches; the extension of these patches by a loosening and fall- 
ing of the hair at a portion or the whole of the periphery; and 
a marked tendency to spontaneous recovery. The first bald 
spot in this affection may occur upon any portion of the scalp, 
and is usually the size of a ten-cent piece or larger when first 



ALOPECIA AREATA. 6 

discovered. It is unaccompanied by itching or any sign of 
inflammation, and may Lave existed for many weeks before 
cutting of the hair or a casual examination of the scalp brings 
it to light. In exceptional cases tenderness upon pressure, 
anaesthesia, hyperemia, oedema, marked pallor or depression of 
the patch, are symptoms which have been noted, but ordinarily 
a partial or complete loss of hair is all that can be seen. The 
original patch sometimes remains single, but usually other 
patches develop near the original one, and frequently, by increase 




Fig. 2. - Serpiginous form of alopecia areata. 

in size and coalescence, denude a considerable portion of the 
scalp, as is shown in the accompanying plate and in Fig. 2. 
The irregular area from which the hair has fallen is smooth and 
soft, and, unlike a patch from which the hair has been epilated 
or shaven, the mouths of the hair follicles are scarcely percep- 
tible. In some cases the bald patches are numerous, of varying 
size, and show little tendency to run together. The affection 
is by no means limited to the scalp, and in severe cases the 
eyebrows and lashes also suffer. In adults the bearded portion 



4 SKIN DISEASES OF CHILDREN. 

of the face and other hairy parts may present bald areas or 
appear completely denuded. 

When first discovered the patch is usually tending to increase 
slowly in circumference, and the hairs at the margin of the disc 
are so loosened in their follicles' that several can be pulled out 
at a time without giving the patient the slightest pain. Often 
the loose hairs will only be found on one side of the patch, and 
extension in this direction is certain to follow. Examined be- 
neath the microscope these loose hairs will be found to be atro- 




Fig. 3.— Growth of white hair on patches. 

phied toward the root, and in some cases they will break near 
the surface of the skin. This breaking of the hairs does not 
leave a short, stiff stubble like that which is characteristic of the 
patches of ringworm, but as the broken-off roots of the affected 
hairs in alopecia areata project from the scalp near the margin 
of the patch, they may be noted as short, fine hair tapering down- 
ward and sometimes suggesting a crop of exclamation points. 

The extent to which alopecia areata will develop in a given 
case it is difficult to determine in advance, but sooner or later in 



ALOPECIA AREATA. O 

most cases, and especially in those cases occurring in childhood, 
the cause seems to have ceased to act and the hair returns. A 
fine, downy growth may be seen over a portion or the whole 
extent of the bald patch, and gradually the baldness disap- 
pears. In some cases, and especially in children with dark 
hair, the new growth is at first colorless and presents quite a 
contrast with the normal hair (Fig. 3). If this new hair per- 
sists in growing, it is certain to become pigmented in due time 
and assume a natural color. But unfortunately in some cases 
this new growth does not persist. It grows just enough to 




■ 



..,.;■-,'■' 




Fig. 4.— Complete loss of hair. 



delude one into a hope of speedy recovery, and then begins to 
loosen and fall out. Even a temporary growth, however, is 
encouraging and warrants the prediction that sooner or later 
the disease will come to an end. In many cases two or three 
months will find the hair growing naturally over the whole 
scalp, while in other cases the affection, through a stubborn 
persistence or a succession of relapses, may last a year or two. 
In adults a complete loss of hair is often irremediable, but in 



SKIN DISEASES OF CHILDREN. 

children the prognosis is comparatively favorable even when 
the head is as hairless as a billiard ball (Fig. 4). 

The etiology of alopecia areata is a vexed question. Despite 
the great amount of study and careful observation which has 
been devoted to this interesting affection, there is much differ- 
ence of opinion as to its pathology, and its true nature still 
remains obscure. For a long time it was believed to be a 
neurotic affection, the bald patch resulting from a faulty in- 
nervation of the affected area. With the development of the 
germ theory of disease there has arisen a strong belief on the 
part of many dermatologists that the affection is parasitic in 
character. Clinical facts are not wanting in support of either 
view, but, while the facts are indisputable, it cannot be ad- 
mitted that they prove beyond all shadow of a doubt the truth 
of either the neurotic or parasitic hypothesis. Recently it has 
been suggested, in view of the conflicting facts and theories, 
that there are two varieties of the affection, one of which, oc- 
curring in epidemic form, must certainly be parasitic. With- 
out attempting to introduce evidence and argue the question, 
it is sufficient to state that the nature of this disease is still sub 
judice and will doubtless so remain until more careful obser- 
vations have been made or stronger arguments presented upon 
one side or the other. The disease occurs in both sexes, but is 
said to be somewhat more frequent among boys than among 
girls. It has been claimed that cats and other domestic ani- 
mals suffer from the affection, and cases have been reported of 
its transmission from these to their human playmates ; but in 
this connection the question naturally arises as to the correct- 
ness of the diagnosis between alopecia areata and ringworm, 
which not infrequently originates in this manner. 

In the treatment of alopecia areata no brilliant results have 
been obtained. Many cases recover spontaneously in a short 
time, while in other cases the most assiduous and persistent 
treatment fails to effect any notable result. Many remedies 
are recommended and certain methods of treatment are war- 
ranted to cure in so many weeks, but, however valuable these 
methods may be in the hands of their originators, they often 
fail utterly when employed by other hands. I have photo- 
graphed many cases and have observed that a few of these 
have gotten well speedily without further treatment. But 
photography will not cure all cases ; neither will some of the 
vaunted methods of treatment, as I have had occasion to learn 
from experience. In fact it must be frankly confessed that the 



ALOPECIA AREATA. 7 

treatment of alopecia areata is in many cases by no means as 
satisfactory as one might wish. Patients sometimes go from 
one physician to another, and fortunate is he who happens to 
take charge of the case at the time when the unknown cause 
has ceased to act and the hair is disposed to return. Unfortu- 
nate is he, however, if he jumps at the baseless conclusion that 
his plan of treatment in this case is wonderfully efficacious and 
will cure other cases with equal rapidity. 

But treatment in alopecia areata, although it may not be pro- 
ductive of brilliant results, is capable of doing some good in 
the way of hastening a cure ; and since the patient usually de- 
mands some kind of treatment, the physician is certainly justi- 
fied in doing the best he can under the circumstances. The 
practical question at once arises, " What is the best thing that 
he can do ? " 

The first step to be taken is to prevent any possible spread of 
the disease to those who come in contact with the patient. If 
only in deference to the view held by excellent authorities 
that the affection is of a contagious nature, it is well to insist 
that every patient should have his or her own brush and comb 
and use no others. As to whether children with alopecia 
areata should be allowed to attend school, a difference of 
opinion might arise according to the opposite views held as to 
its contagious nature. But since the disease is only slightly, if 
at all, contagious, it would hardly seem justifiable to keep a 
child at home who is undergoing proper local treatment. 

Whatever will stimulate the scalp and draw the blood to the 
pale, hairless patches will tend, in my opinion, to promote the 
growth of hair. And this can be done without the infliction 
upon the patient of either pain or discomfort. Nearly all of 
the powerfully stimulating applications are parasiticide in their 
action, and are therefore indicated, whether one believes in 
the neurotic or the parasitic origin of the disease. The benefi- 
cial effect results from the artificial congestion of the patch, 
whether the action of this be to arouse the dormant nerve fila- 
ments or to check the development of a micro-organism. 

The galvanic current is perhaps the best stimulant that can 
be used ; but as the patient cannot conveniently have electricity 
applied two or three times a day, it is more advisable to pre- 
scribe some stimulating lotion or ointment. The liquor am- 
monise fortior U. S. P. I have used for many years and in many 
cases ; and, while it may be no better than other stimulating 
applications which tend to redden the skin, it has certainly 



b SKIN DISEASES OF CHILDREN. 

appeared to do as much good as any one of the many other 
remedies which I have tried. If something more parasiticidal 
in its action is desired, an ointment of chrysarobin from three 
to ten per cent in strength can be recommended as an effective 
application. In prescribing this the physician must not forget 
to mention the fact that it will stain the bed linen, and caution 
the patient not to get any ointment in his eyes lest a severe 
conjunctivitis result. 

The plan long recommended and often practised of shaving 
the scalp and blistering the patches with cantharis, croton oil, 
or pure carbolic acid, may be of some value, but not enough 
to compensate for the suffering which it involves. Although 
patients will sometimes stand any amount of painful treatment 
in order to get cured, there is no justice in submitting them to 
harsh measures when milder ones are of equal value. 

Epilation of the loose hair at the margin of the bald patch is 
advisable, since it seems in some cases to prevent the spread of 
the disease ; but general epilation is unnecessary, and, so far as 
I know, is never practised in America. 

A patient seen recently by the writer has had alopecia areata 
for ten years. Two months after marriage his wife found 
three bald spots upon her own head. At a European health 
resort the physician who was consulted, evidently believing in 
the parasitic origin of the disease, ordered the hair to be epi- 
lated not only on the scalp but on other hairy parts of the 
body. The spots persisted, and complete epilation was re- 
peated in the case of both husband and wife. The lady's maid 
complained of slight falling of the hair, and her scalp was 
ordered to be thoroughly epilated, in spite of her indignant pro- 
test. In these cases, which illustrate the absurd extreme to 
which theoretical therapeutics may be carried, the vigorous 
treatment would have been pardonable had it been successful, 
but the gentleman, an extremely nervous individual, has still 
bald patches upon his scalp and chin. 

Of internal medication it need only be said that neither 
arsenic, jaborandi, nor any other drug in the pharmacopoeia is 
capable of producing any manifest result in most cases. They 
may be of some value, as has been claimed, but reliance upon 
them is usually disappointing. The restoration of hair after 
administration of a drug is no proof of its value in a single case. 
The absence of improvement after its use in repeated cases is 
at least suggestive of its inertness. Any internal medication 
which will improve the physical condition of the patient is of 



ALOPECIA AREATA. 9 

course advisable and may tend to hasten the cure of alopecia 
areata. But in this affection impairment of health rarely 
seems to be a predisposing cause, and in many cases the patient 
is apparently in perfect health. 

The uncertain result of treatment in alopecia areata should 
always lead to a guarded prognosis. In most cases a cure can 
be promised, but it is never advisable to specify any given time 
at which it may be expected. The younger the patient, the less 
the extent of baldness, and the more recent its development, 
the better will be the prospect of a speedy return of hair. 



PLATE II 




TRICHOPHYTOSIS CAPITIS. 

From the collection of photographs of 

Dr. GEORGE HENRY FOX. 



EINGWORM AND FAVUS. 



There are few if any cutaneous affections so ineffectually 
and unsuccessfully treated by the physician in general practice 
as are ringworm and favus. The family physician who as- 
sumes to understand and undertakes to treat (as every family 
physician should do) the common affections of the skin is often 
guilty of serious malpractice in the management of these para- 
sitic affections. The diagnosis is generally made without diffi- 
culty, although mistakes will sometimes occur in the best-regu- 
lated practice. But, granting that the diagnosis is speedily 
and correctly made, the treatment commonly employed is so 
poorly adapted to the requirements of the case and so imper- 
fectly carried on, that many incipient cases, which ought to be 
cured by a few weeks of vigorous treatment, are allowed to 
persist for months or years, it may be, and to become so chronic 
and intractable that even the most skilful treatment must then 
require a long period of time and much patience to effect a 
cure. Nor is this the only baneful effect of this feebleness of 
therapeutic efforts. Other children in the family, the school, 
or the vicinage are permitted to contract the disease, while the 
physician treating the original case remains blissfully ignorant 
of the ever-increasing debt of suffering which is his just due. 
Therapeutic incompetence may appear less criminal than wilful 
neglect, but the results are equally unfortunate, and in the 
treatment of these common parasitic affections the physician 
ought not to be guilty of either charge. 

There are three common affections of the skin due to the 
presence of a vegetable parasite — viz., favus, trichophytosis 
(ringworm), and chromophytosis (tinea versicolor). As the 
latter is rarely if ever met with in childhood, it may be left out 
of consideration at present; and since the remaining two, 
though distinct in origin and clinical features, are allied in 
nature and call for similar methods of treatment, it will be 
convenient to consider them together. 



12 



;kin diseases of children. 



Upon non-hairy parts, such as the face, neck, hands, and 
trunk, ringworm begins as a minute, slightly reddened, scaly 
disc, which gradually enlarges. When it has reached the size 
of a ten-cent piece the advancing border appears elevated while 
the centre tends to become smoother, and the lesion presents 
an oval, circinate, or " ring "-like appearance (Fig. 5). In rare 
cases a circle of fine vesicles can be detected at the periphery. 
One or more rings may be present, and the coalescence of two 




Fig. 5.— Trichophytosis corporis. 

or more may produce an irregular patch like a figure of eight 
or a trefoil. Occasionally when the ring has attained consid- 
erable size red papules or new foci of disease may appear in 
the smooth and perhaps slightly pigmented centre, and by 
gradual development may produce two or even more concentric 
rings. 

Favus developing upon non-hairy parts produces scaly discs 
which at first are not readily distinguishable from the lesions 
of ringworm; but soon upon the branny surface a minute yel- 



RINGWORM AND FA VUG. 13 

low, cup-shaped crust of the size of a pin's head will develop, 
which at once settles the question of diagnosis. These bright- 
yellow, pin-head cups multiply and by coalescence form a sul- 
phur-colored crust which is quite characteristic (Fig. 6). 

Ringworm and f avus of non-hairy parts cannot be considered 
as serious affections, but when the parasitic fungus of either 
finds its way into the hair follicles upon the scalp, as often 
happens with children, the case is quite different. The unfor- 

r— -■-- * ........ , 





Fig. 6.— Favus corporis. 

tunate child is now the victim of an extremely obstinate dis- 
ease, and, unless judicious measures are adopted without delay, 
is doomed to months or perhaps years of annoyance, if not of 
actual suffering. Upon the scalp these affections are always 
obstinate, and when this fact is not appreciated by the physi- 
cian in charge of the case, and inefficient measures are adopted, 
the case usually goes from bad to worse until a cure seems 
nearly hopeless. 

The first indication of ringworm of the scalp is commonly a 



14 



SKIN DISEASES OF CHILDREN. 



small scaly disc, which appears almost bald from the breaking 
of the hairs close to the surface (Fig. 7). This dry, roughened 
patch, with its characteristic growth of short, broken hairs, 
tends to enlarge if allowed to go untreated (see plate), and 
other discs are apt to develop in the vicinity or upon other por- 
tions of the scalp. Frequently a large number of scaly points 
or small discs may be found involving the greater portion of 
the scalp and constituting what is known as disseminated ring- 




Fig. 7.— Trichophytosis capitis. 



worm (Fig. 8). Neglect in such a case is usually followed by 
a coalescence of the patches and disease of nearly the whole 
scalp. Not infrequently an eczema complicates the ringworm 
and obscures the diagnosis. 

In rare cases the ringworm fungus, instead of producing 
scaly discs, sets up a deep-seated inflammation of the hair fol- 
licles, and a bald, fluctuating tumor or a cluster of boggy, 
rounded elevations forms upon the surface of the scalp. This 
condition is generally painful, and is known as kerion or the 



RINGWORM AND FAVUS. 



15 



kerionic form of ringworm. The suppuration often loosens the 
hair, and in these cases complete baldness is more frequently 
found than the stubble-like growth of hair which characterizes 
the ordinary form of the disease. According to recent observa- 
tions, this form of ringworm is due to a special fungus which 
also affects the lower animals. 

In f avus of the scalp there are no broken hairs found as upon 
the discs of ringworm, and the diagnosis is usually based upon 




Fig. 8.— Trichophytosis disseminata. 



the presence of the minute yellow, cup-shaped crusts which 
develop at the orifices of the hair follicles. When these are 
allowed to multiply, a thick, pale-yellow, friable crust forms, as 
is seen in the well-marked case (Fig. 9) which was originally 
published in the author's "Photographic Illustrations of Skin 
Diseases. " Much has been said about the peculiar odor of f avus 
as a basis of diagnosis. While it is true that in a neglected 
case, where the crusts have accumulated, a keen scent combined 
with a vivid imagination may perceive a fragrance which is 



16 



SKIN DISEASES OF CHILDREN. 



quite suggestive of " mice/' " putrid urine," or "an ill-kept 
menagerie," the diagnosis can be far more readily made from 
the characteristic appearances. In doubtful cases, moreover, 
in which there are no characteristic crusts, the peculiar fa- 
vic odor is not likely to be perceived by ordinary olfactories. 
While typical cases of ringworm and f avus are totally unlike 
in their clinical appearance, treatment often obscures the char- 
acteristic features, and hence, in cases where the crusts have 




Fig. 9.— Favus capitis. 



been removed, the differential diagnosis may sometimes be 
attended with difficulty. In ringworm, however extensive and 
chronic the case may be, the hair is not apt to be permanently 
destroyed ; while in favus the pressure of the crusts which de- 
velop in the epidermic layer around the orifices of the follicles 
tends to produce atrophy of the hair bulbs, and in all cases of 
long standing a few bald, depressed, and cicatricial areas are 
generally observed, and upon these the hair will never grow. 
In chronic cases, even after the disease has been cured, a num- 



RINGWOEM AND FAVUS. 17 

ber of wiry, twisted, or deformed hairs are usually seen grow- 
ing around or among these cicatricial patches. 

Trichophytosis capitis is a disease of youth, and even when 
allowed to go untreated it will tend to a spontaneous cure as 
the patient matures. Though ringworm of the beard is very 
common in men, for some inexplicable reason ringworm of the 
scalp is never met with in adult life in either male or female. 
Favus, on the other hand, occurs at all ages. Developing in 
youth, it may persist indefinitely, although it is far more fre- 
quent in childhood than in adult life. 

The cause of ringworm and favus is the presence in the epi- 
dermis and hair follicles of a micro-organism, the growth of 
which gives rise to more or less inflammation and the charac- 
teristic clinical appearances already described. The parasitic 
fungus causing ringworm is the trichophyton. Several varie- 
ties have recently been described, but it is not as yet satisfac- 
torily proven that these varieties of the fungus are the cause of 
all clinical variations noted in the course of the disease. The 
etiological factor in favus is the achorion. This fungus does 
not penetrate the shaft of the hair as readily as does the tri- 
chophyton, and hence the absence in favus of the broken hairs 
which are so characteristic of ringworm. Children in perfect 
health are liable to contract either disease from some child 
already affected, or possibly from some pet animal. No par- 
ticular condition of the skin is necessary to furnish a congenial 
soil for the development of the parasite, although it is true that 
in weak, poorly nourished children whose heads are often moist 
the disease is more, likely to thrive and the inflammatory symp- 
toms to be more marked. Age, however, seems to modify the 
character of the soil in a notable degree, and it is well to re- 
member the clinical fact, already mentioned, that ringworm of 
the scalp, so common in childhood, is never seen in adult life. 
In like manner ringworm of the beard, so frequently seen in 
middle life, is quite exceptional among old men. 

In the treatment of ringworm and favus a host of local appli- 
cations are recommended by dermatological writers, which only 
proves that the majority of them are of very little value. 
Moreover, an admirable prescription may be written, but if the 
nurse or person in charge of the patient is not given full and 
explicit directions as to how the treatment should be carried 
out, the result is certain to be unsatisfactory. The local remedy 
employed is often of far less importance than the exact method 
of its use, and attention to minute details which may seem 



18 SKIN DISEASES OF CHILDREN. 

unimportant to the inexperienced is always the key to success. 
In no other affections of the skin are intelligence and persistence 
so essential, and for the exercise of these in the daily care of the 
patient the physician should hold himself responsible. 

On non-hairy parts ringworm and favus can be readily cured 
by almost any parasiticide. A ten per cent ointment of salicylic 
acid is an effective application, or, if the skin is very delicate, 
it may be better to simply moisten the patches frequently with 
a saturated solution of sodium hyposulphite in rosewater. But 
when the scalp is affected the cure is always a difficult one, and 
the first step is to impress upon whoever is in charge of the case 
the important fact that half-way measures will do little or no 
good. It is always advisable to shampoo the scalp thoroughly 
once a day, especially if the hair is short, as this gives the para- 
siticide application a much better chance to penetrate the hair 
follicles. The neglect of frequent and thorough washing of the 
scalp is the chief cause of the frequent therapeutic failures. 
When this is carefully attended to, the thorough inunction 
twice daily of sulphur ointment, oleate of mercury, or chrysa- 
robin ointment (ten per cent) is certain to do good. If a cap is 
worn by the patient, as is advisable, it should be fastened to 
the head by a ribbon or strip of bandage, and not by a rubber 
band, on account of the serious results which might ensue from 
a prolonged stoppage of the circulation. 

There is one remedy which is indispensable in chronic cases 
and of the greatest value in any case. It is epilation. It must 
be admitted that this is always troublesome to the physician or 
nurse who undertakes to carry it out, and more or less painful 
to the patient. But it saves time and trouble in the end. With 
a well-made pair of epilating forceps, which should be light and 
broad at the end of the blades, the short hairs can be firmly 
caught and quickly pulled out. It is advisable to epilate first 
the long hairs around the margin of a patch until a narrow 
white ring of healthy scalp appears. This will prevent any in- 
crease in size of the patch, and the short hairs upon the red- 
dened, scaly surface of the patches can be pulled at leisure. 
As many of these will break in the process of epilation, the 
operation must be repeated until the patch is quite bald and 
begins to assume a comparatively healthy appearance. The 
epilation and the application of parasiticides can be carried on 
at the same time. When the inflammation has subsided and 
the scaling disappeared, and all the patches have assumed a 
comparatively healthy appearance, the hair may be allowed to 



RINGWORM AND FAVUS. 19 

grow and all treatment suspended save the daily use of a five 
per cent salicylated oil. If, however, at any time a slight 
scaliness or dry, brittle appearance of the hair is noted at any 
point, it is advisable to epilate again and convert the suspicious 
spot into a small bald disc. This plan of treatment is best cal- 
culated to effect a certain if not a speedy cure, but often it will 
require months of patient and persistent treatment, and per- 
haps a year or more in exceptionally extensive and chronic 
cases. 

The parents or guardians of the patient should always be 
apprised at the outset of the obstinacy of the disease and its 
unfavorable prognosis as regards a speedy and pleasant cure, in 
order to avert the discouragement and dissatisfaction with the 
method of treatment which otherwise would naturally ensue. 

It seems hardly necessary to add that no child with ringworm 
should be allowed to attend school. If our city Board of Health 
could make provision for a periodical inspection of the public- 
school children, with a view to checking the spread of ring- 
worm and other contagious diseases, a considerable amount of 
suffering and expense could be saved to a certain number of 
scholars and their parents. Furthermore, if some careless 
physician were sued for malpractice for allowing an uncured 
case of ringworm or favus to attend school, simply because 
upon a hasty inspection, without the use of a microscope, he 
thought the child was all right, it might be unfortunate for the 
physician, but by no means a bad thing for the profession. 



IMS 




From the collection of photographs of 



CONTAGIOUS IMPETIGO. 



The affection known as contagious impetigo, though a very 
common one, is by no means as clearly denned as other derma- 
toses of frequent occurrence. Crusted lesions or scabs resulting 
from the use of the finger nails and the drying of a copious 
blood-stained secretion are frequently seen upon the faces of 
children, but the origin and nature of this eruption are not 
always plain. That the lesions are contagious and auto-inocu- 
lable is a matter of simple observation, and that pus cocci play 
an important part in their development is generally admitted. 
Mothers and nurses are often affected by children under their 
care. 

It is undoubtedly the presence of micro-organisms which oc- 
casions the crusted or impetiginous form of eczema (the crusta 
lactea, or milk crust of infants). In these cases we have an 
ordinary eczematous inflammation of the skin due to some in- 
ternal condition, but the peculiar clinical aspect of the eruption 
— viz., the suppuration and crusting — is without doubt due to 
the external agency of pyogenic microbes. In other cases 
minute aggregated pustules develop superficially and exude an 
abundant honey-like secretion which dries into yellow, gummy 
crusts of varying size and irregular outline. This eruption is 
comparatively rare, affects adults as well as children, and is by 
some regarded as a pustular eczema and by others as impetigo 
or contagious impetigo. In fact it is difficult to determine in 
practice precisely what cases should be included under the last- 
named affection, but a large number of cases occurring in chil- 
dren present certain definite lesions which are readily recog- 
nized and indicate an identity of origin. 

In a typical case of contagious impetigo (and it is question- 
able whether there is any impetigo which is not contagious) the 
lesion is usually a flattened vesico-pustule. This is small at 
the outset, superficial, and without any surrounding area of in- 
flammation. It is always single, although when the pustules 



22 



SKIN DISEASES OF CHILDREN. 



are very numerous, a number of them in close proximity may 
appear like an irregular group. When this lesion escapes being 
scratched, and thereby altered in appearance, it tends to in- 
crease peripherally and to become depressed in the centre. It 
usually reaches its maximum development in a few days, and 
is about the size of a five-cent nickel. At the advancing bor- 
der the epidermis is raised by a milky, purulent secretion 
while the depressed centre appears of a darker hue. Upon the 
back of the fingers or hand, where, next to the face and scalp, 




Fig. 10. — Contagious impetigo. 

the lesions are most common, they look like recent and acci- 
dental burns. Upon the palm, where the thicker epidermis is 
less likely to be ruptured, the lesions are apt to present the 
appearance of hemispherical or flattened pustules, quite similar 
to, though somewhat larger than, the pustules occasionally ob- 
served in scabies. After an existence of about a week the con- 
tents of the pustules tend to dry into yellowish, honey-like or 
* ' straw-colored " crusts. If the lesions remain uninjured by the 
finger nails, the affected skin gradually heals and the crusts 



CONTAGIOUS IMPETIGO. 



23 



appear as though " stuck on " to the cutaneous surface. When 
thoroughly dried these crusts fall, and even when picked or 
rubbed off they leave no ulcerated surface, but merely a small 
hypersemic area. 

It is only in exceptional cases, however, that this natural and 
characteristic evolution of the lesion can be observed, for in 
children, especially, the irritation of the lesions usually pro- 
vokes scratching, which changes their clinical appearance, and 
a little blood mingled with the purulent secretion gives rise to 




Fig. 11 —Confluent lesions of impetigo. 

the formation of a dark crust or scab. Upon the extremities, 
especially the legs, friction of the clothing, dirt, and constant 
scratching frequently inflame the lesion, and a dark crust upon 
a superficial ulceration with a narrow red areola is produced, 
which has generally been described as a distinct skin affection 
under the name of ecthyma. These ecthymatous pustules, com- 
mon in cachectic children, are often associated with the charac- 
teristic lesions of contagious impetigo upon the face and hands 
and are evidently of similar if not identical origin. 



24: 



SKIN DISEASES OF CHILDREN. 



In certain cases of vaccination a double infection may some- 
times take place. When the vaccine virus has produced a vesi- 
cle, the microbes of contagious impetigo may be accidentally 
implanted. The vaccine lesion now becomes unusually inflamed 
and itchy. Through scratching a number of other crusted 
lesions are developed upon the arm and elsewhere, and doubt- 
less some of the cases of generalized vaccinia which have been 
reported may be justly considered to have been cases of con- 
tagious impetigo beginning at the point of vaccination. 




Fig. 11.— Umbilicated lesion on forehead. 

Upon the scalp the lesions of contagious impetigo are fre- 
quently found, and usually appear as small, isolated, circular 
crusts. These frequently occasion temporary areas of partial 
baldness, and when the disease is of long standing and there is 
very much suppuration a permanent loss of some hair may re- 
sult. The affection is often associated with pediculosis capitis, 
and in such a case the frequent scratching of the head is very- 
apt to multiply the lesions, and often the diagnosis is obscured 
by the development of eczema upon the scalp and back of the 



CONTAGIOUS IMPETIGO. 25 

neck. In impetigo of the head and face the cervical and sub- 
maxillary glands are very apt to become enlarged and tender, 
and in strumous, ill-nourished, and neglected children glandu- 
lar suppuration may occur. Among this class the affection 
frequently coexists with paronychia and ulcers of the conjunc- 
tiva and buccal mucous membrane. It is said to occur with 
especial frequence in female children and in the spring, al- 
though neither sex nor season is exempt. 

The upper illustration in the accompanying plate shows 
crusted lesions upon the forehead and scalp, and a secondary 
conjunctivitis which has closed the right eye. Upon the hand 
a number of incipient pustules are seen, excoriated upon the 
fingers, but tolerably well developed upon the wrist. Upon 
the forearm, in the lower illustration, a few typical flattened 
and umbilicated lesions may be seen, while upon the arm an 
ecthymatous patch has resulted from the coalescence of several 
scratched and crusted lesions. In Fig. 10 the eruption presents 
its characteristic appearance in the form of numerous isolated 
crusted lesions. In Fig. 11 a few lesions have coalesced upon 
the lips and formed a large, crusted patch resembling impetigi- 
nous eczema. In Fig. 12 the lower lip is similarly affected, 
while upon the forehead the isolated lesions present a typical 
appearance. 

While the individual lesions of contagious impetigo run an 
acute course of a week or ten days, the development of new 
lesions and the irritation produced by scratching often keep up 
the eruption for many weeks. In its treatment cleanliness is 
of the utmost importance, especially as the affection is most 
likely to occur among children whose ablutions are neither fre- 
quent nor thorough. The finger nails may be advantageously 
cleansed and cut, and a disinfectant lotion, such as listerine 
or a saturated solution of sodium hyposulphite in rosewater, 
should be applied frequently to the affected skin. To remove 
crusts and heal superficial ulceration an excellent application is 
a mixture of equal parts of white precipitate ointment and cold 
cream. 



Plate: iv. 




From the collection oF photographs oh 



PSORIASIS. 



Psoriasis, though most frequently met with after the age 
of puberty, is by no means a rare affection in childhood and 
may even occur in infancy. Though different cases present a 
notable variation in their clinical appearance, the characteris- 
tic features of the disease are very much the same at all ages. 
The eruption is always dry and scaly, whatever may be the age 
of the patient, but in childhood it is not generally so well de- 
veloped and so extensive as it is apt to be in later years. 

Psoriasis begins in the form of one or more red points, which 
quickly become covered with white, silvery scales (Fig. 13). 
These may be readily scratched off by the finger nail, and 
when this is done a bleeding surface is exposed. When many 
of these small, scaly lesions are present the eruption is described 
as punctate psoriasis, and this form of the eruption is compa- 
ratively more frequent in children than in adults ; when the 
scaly lesions increase in size and appear like drops of grease or 
thin mortar spattered over the skin, we have the guttate form 
of the disease (Fig. 14) ; and when the patches assume the size 
and shape of silver coins they are often described as nummu- 
lar psoriasis (Fig. 15). By healing in the centre these lesions 
may be converted into scaly rings, or by peripheral increase 
and coalescence they may result in the formation of extensive 
scaly patches (Fig. 16). Diffused or general psoriasis is, how- 
ever, rarely met with among children. 

The amount of scaliness present in any case depends upon 
the attention which the patient naturally devotes to his skin. 
If baths are frequently taken, and especially if any fat or oil is 
rubbed over the patches, the scales are generally absent and 
the eruption presents a tolerably smooth, reddened appearance. 
When no attention is paid to the care of the skin, the scales 
often accumulate upon the psoriatic patches until they are very 
prominent and present a silvery-white or dirty-yellow appear- 



28 



SKIN DISEASES OF CHILDREN. 



ance. As the eruption tends to disappear the scaling grows 
less, often disappearing from the centre of the patch and leav- 
ing a marginate ring. Finally the redness fades and the skin 
assumes a normal appearance, except in certain cases where 
pigmentation may occur. 

In rare cases of psoriasis the eruption may tend to rapidly 
involve the whole skin. The cutaneous congestion is severe, 
and large flakes of partly detached epidermis may take the 
place of the silvery scales. In other words, an attack of acute 




Fig. 13.— Punctate lesions covered with white scales. 

dermatitis exfoliativa has set in and complicated and obscured 
the psoriasis. When the dermatitis has subsided the psoriasis 
is very apt to reappear. 

Psoriasis is not only a dry and scaly eruption, but it is inva- 
riably marginate. Whether occurring in small discs or in 
large, irregular patches, the border is always sharply defined 
and never shades off gradually into the surrounding healthy 
skin, as does the ordinary patch of eczema. This is a diagnos- 
tic point of great importance. In many cases of eczema the 



PSORIASIS. 



29 



patches may be dry and scaly, and present a resemblance to 
those of psoriasis, but the rounded, silvery discs or larger mar- 
ginate patches of the latter disease are usually so characteristic 
that an error in diagnosis is not likely to be made. 

The localization of the eruption is another important diagnos- 
tic point. While eczema may appear upon almost any part of 




Ftg. 14.— Guttate lesions with scales washed off. 

the body, and often exhibits a tendency to attack the flexor 
aspect of the joints and other parts where the skin is thin and 
delicate, psoriasis is commonly seen upon the extensor surface 
of the extremities and is especially apt to be noted about the 
elbows and knees. Upon the scalp the two affections often 
present a strong resemblance, but in psoriasis the scaly patches 



30 



SKIN DISEASES OF CHILDREN. 



are apt to be small, numerous, and circular, with healthy skin 
intervening, while eczema of the scalp usually occurs in one 
large, diffused patch. 

The symmetry of the eruption in psoriasis is also a charac- 
teristic feature. The eruption upon one extremity or one side 




Fig. 15.— Nummular and circinate psoriasis. 



of the trunk is usually duplicated upon the other side, while 
eczema is very frequently unilateral. 

The papular syphilide often assumes a squamous form and 
presents for a time a strong resemblance to psoriasis. For- 
tunately it is rarely met with in childhood, but at any age it 



PSORIASIS. 



31 



differs from psoriasis in one respect. While in the latter affec- 
tion the infiltration of the skin is slight and the accumulation of 
scales a prominent feature, in the papular syphilide the infiltra- 
tion of the skin is considerable and the scaling is comparatively 
slight. 

It is a noteworthy fact that many patients suffering from 




Fig. 16.— Patches healing in centre, enlarging and coalescing. 



psoriasis are unusually well developed and robust in appearance. 
It is not, like eczema and certain other skin affections, a disease 
of the weak and the neglected, but one which seems to delight 
in attacking those who are strong and well nourished. In any 
case, however, where the tendency to psoriasis exists, the erup- 
tion is certain to be most severe whenever the patient is weak- 
ened by lack of proper food or by overwork. 



32 SKIN DISEASES OF CHILDREN. 

The tendency to psoriasis is frequently inherited, and often 
the disease may be observed in two or more generations. Not 
infrequently it shows a tendency to skip a generation, and it 
has been claimed that psoriatic subjects are the offspring of 
eczematous, dyspeptic, asthmatic, gouty and rheumatic, as well 
as of psoriatic parents. External irritation only produces the 
disease in those who manifest a predisposition to it. 

While it is often an easy matter to remove the eruption by 
treatment, it is difficult, if not impossible, in many cases, to 
prevent its speedy return. The eruption shows a marked ten- 
dency to relapse or to increase in severity in the spring or at 
some particular season, and in many cases persists for years or 
even throughout a lifetime. It often improves or disappears 
spontaneously for a few months or even for a year or more, 
and then reappears and continues its fluctuating course. The 
prognosis, therefore, is always a grave one as regards the per- 
manent cure of the disease; but, in spite of the fact that some 
have declared psoriasis to be incurable, there are many cases 
which get well and remain well. 

In the treatment of psoriasis a host of remedies have been 
employed, and many of them owe their repute to the fact, 
already stated, that the eruption tends at times to disappear 
spontaneously, and to any remedy employed at such a time the 
credit of a cure would naturally be awarded. 

Among internal remedies, arsenic is the one most commonly 
employed and probably the most efficacious. In many cases, 
however, it may do much more harm than good. When the 
skin is irritable and the psoriatic patches congested, arsenic is 
worse than useless and alkaline diuretics are greatly to be pre- 
ferred. But, on the other hand, when the disease is tending to 
get well, the administration of arsenic will often produce a most 
brilliant therapeutic result. 

Of th^ various local remedies employed, chrysarobin stands 
without a rival. In many cases it produces a speedy and bril- 
liant result which can be attained by no other local application. 
It has serious objections, however, which often forbid its use. 
When the skin is irritable it may cause the eruption to spread. 
Like arsenic, it is most likely to do good when the acute con- 
gestion of the psoriatic patches has subsided and the eruption 
is tending toward a spontaneous improvement. It not only 
stains the skin temporarily — which, however, is a matter of 
little importance — but it permanently discolors the undercloth- 
ing and the bed linen, if due precaution is not taken. When 



PSORIASIS. 33 

rubbed in where the skin is thin, or near it, as, for example, the 
axillse and flexures of the joints, it often excites a very un- 
pleasant dermatitis for a few days; and when by chance a little 
of the ointment gets into the eye a very severe conjunctivitis 
often results. This chance is somewhat lessened by applying 
the drug in the form of a varnish composed of gutta-percha 
solution or collodion, but then its therapeutic effect is decidedly 
lessened. Upon the trunk and extremities a five or ten per 
cent ointment, made by rubbing up finely sifted chrysarobin in 
vaseline, can be advantageously used; but upon the scalp and 
face the ointment of ammoniated mercury will generally prove 
efficacious, and is to be preferred to the chrysarobin. 

Prolonged baths are often of service in macerating the scaly 
patches, and, when the skin is not too irritable, soap frictions 
are valuable in removing the scales and preparing the skin for 
inunction. In many cases, however, owing to the intense con- 
gestion of the affected skin, a hot bran or alkaline bath will 
prove more agreeable than the use of soap. 
3 



I® ¥. 




f PHOTOGRAVURE ' 



UJ 



From the co/lechon of photoqrapfs of 

Z&hr c/ / e4??'--'//es <-sCe?i&'-u/ ^fsx*>. 



ICHTHYOSIS. 



Ichthyosis is a deformity or an imperfect development rather 
than a disease of the skin. Like all deformities, it is very apt 
to be hereditary, affecting one or more members of a family, 
and often skipping a generation. It is characterized by a 
marked deficiency of the normal cutaneous secretions and a 
tendency to the formation of a dry, scaly surface, which sug- 
gested the name of "fish-skin disease." It is sometimes con- 
genital, may indeed develop in utero, but often does not mani- 
fest itself until several months after birth. In rare instances it 
may develop late in life. Though always improved by judi- 
cious treatment, it may be considered as one of the incurable 
dermatoses, since the peculiar character of the skin cannot be 
changed. 

There are various degrees of severity in which ichthyosis 
may manifest itself, and different names applied to these have 
led to some confusion as to their true character. For instance, 
the term xeroderma, or "parchment skin," has been used un- 
necessarily to designate a very mild form of ichthyosis in 
which the skin presents a dry, mealy appearance, especially apt 
to be noticed in children with whom bathing is a rare luxury. 
In some cases this slight ichthyotic tendency disappears in 
time, and sometimes appears in later life as an acquired condi- 
tion. It should be borne in mind that as the hair in some 
children is preternaturally dry and in others unusually oily, 
and that as this condition may vary in the same individual ac- 
cording to the state of health, so the degree of natural oiliness 
or dryness of the skin may vary greatly in individuals and in 
accordance with season and general condition. A skin which 
is notably dry and with a tendency to chap or roughen might 
be regarded as xerodermatous or ichthyotic in a very slight 
degree. 

In ichthyosis mitis (or simplex) the characteristic features of 
the affection are well developed. The skin is dry, and perspi- 



30 



SKIN DISEASES OF CHILDREN. 



ration is slight even in warm weather. Upon the extensor 
aspect of the extremities the epidermis presents often a peculiar 
serpentine appearance, resulting from the cracking of the horny- 
layer into polygonal plates, which in time assume a dirty gray 
or greenish tint. These plates adhere by the central portion, 







Fig. 1?.— Ichthyosis. 

while the margin tends to separate from the underlying skin. 
Around the elbows and knees the natural wrinkles are greatly 
intensified, and the breaking of the horny epidermis occasions 
a large number of concentric, whitish lines separating rows of 
warty elevations. As a rule the flexures of the joints, axillae, 
groins, genitals, palms, and soles are but slightly if at all 



ICHTHYOSIS. 37 

affected. The face usually presents a characteristic appear- 
ance, the cheeks being roughened or chapped, the eyelids 
stiffened and drawn into a condition bordering on ectropion, 
the lips dry, and the oral commissures more or less wrinkled. 
The hair is usually dry and sparse upon the scalp, and may be 
entirely absent upon those portions of the trunk and extremi- 
ties where a slight growth is usually present. The nails are 
apt to be dry and brittle. 

In cases of ichthyosis of a severe type in which no treatment 
is instituted and the ordinary use of soap and water is neglected, 
the epidermis becomes broken into small plates, which increase 
in thickness until the affected skin upon the extensor aspect of 



Fig. 18 —Ichthyosis with broken epidermis. 

the extremities is covered with more or less conical, blackish 
masses and resembles the bark of a tree. To this condition 
the term ichthyosis hystrix, or " porcupine skin," may be ap- 
plied. It should be borne in mind, however, that this term is 
often used to designate a linear warty condition occurring in 
parallel streaks, usually upon one side of the body (naevus ver- 
rucosus), and which has no clinical relation to ordinary ich- 
thyosis. 

The severest form of the disease is one which develops in 
utero and is frequently fatal shortly after birth. This has 
been described as "diffuse congenital keratoma," "harlequin 
foetus/' etc. Dr. George G. Wheel ock in a report of a case ■ 

1 Illustrated Quarterly of Medicine and Surgery, July, 1882. 



38 



SKIN DISEASES OF CHILDREN, 



states that the forceps were applied through the os and the 
child was with considerable difficulty extracted, there seeming 
to be a total lack of lubrication and consequently great friction 
between the foetal and maternal parts. As the head was born a 
thick plate of skin two inches square was detached and escaped 
with the head. At first the child had the appearance of a dead 
foetus with macerated epidermis, but shortly it began to breathe 
and to cry feebly. Its appearance was horrible in the extreme. 
It was covered from head to foot with a skin like leather, deeply 
fissured and broken up into plates like an alligator or an arma- 
dillo. Many of the plates were separated from the true skin, 
which was of a bright strawberry color. After birth the dried 




Fig. 19.— Ichthyosis with fine scales. 

skin became of a bright chrome yellow, and the plates were 
more and more detached by the motions of the child, which 
lived only six hours. Another case has been reported of a 
woman who had three healthy children by her first husband 
and three ichthyotic foetuses by her second. Cases have also 
been reported of this severe form of the disease developing 
after birth. 

Occasionally one of these cases of severe congenital ichthyo- 
sis may survive. A youth known to fame as the "Alligator 
Boy," and exhibited in a dime museum some years ago, was 
described by the writer in the Journal of Cutaneous and 
Venereal Diseases, April, 1884. The eruption, contrary to 
the rule, was most marked upon the trunk, the epidermis being 



ICHTHYOSIS. 



broken by movements of the body into polygonal, horny plates 
of varying size and of a dirty- yellowish hue. In winter the 
skin upon the trunk was smooth, though thickened and horny 
in character. In the spring this horny integument was wont 
to crack and present the characteristic alligator appearance, 




Fig 20. -Polygonal plates of ichthyosis. 

while the hair of the head was almost entirely shed. At birth, 
according to Dr. F. Kennedy, the child presented a most extra- 
ordinary appearance. The skin was smooth, as if polished, and 
of a deep-red color. It was impossible for the child to make 
use of its facial muscles in its efforts to cry or suck. After a 



40 SKIN DISEASES OF CHILDREN. 

few days fissures occurred and armor-like scales were formed, 
which gradually peeled off. This case was evidently of the 
same nature as those reported by Wheelock, Kyber, and 
others, but not so severe as to cause death. 

Heredity is the only cause which can be suggested for the 
occurrence of ichthyosis, but often the parents and grand- 
parents are said to have been free from this or any other form 
of skin disease. The sexes are about equally disposed to the 
affection. 

The treatment of ichthyosis is of necessity palliative, as the 
cause cannot be removed, but even in the severest cases the skin 
can be softened and restored temporarily to an almost or quite 
normal condition. To maintain this condition a considerable 
amount of persistent daily lubrication of the skin is required. 
The use of fatty articles of food, such as cream, eggs, etc., is to 
be recommended; and cod-liver oil will often prove serviceable, 
although it may not be necessary to use it internally, externally, 
and eternally, as has been suggested. Indeed, for local appli- 
cation the fats and oils do not generally prove as agreeable and 
effective as does diluted glycerin. A half -ounce of this added 
to a pint of rosewater (or rainwater) makes an excellent lotion, 
which can be readily rubbed over the extremities, or whole body 
if necessary, every night and morning. When the disease is 
complicated by eczema, as often happens, a soothing ointment 
or paste is called for. 




From the collection of photographs of 



ECZEMA. 



Eczema is at all ages the most important skin disease which 
the physician is called upon to treat. In infancy and childhood 
it is especially common, and usually a source of great discomfort 
to the patient. A full discussion of the subject would require 
much time and space, and in the few pages allotted to it here 
only a few points can be briefly mentioned and a few practical 
suggestions offered. 

Eczema is an inflammation of the skin, of which the symp- 
toms are commonly redness, thickening, moisture, crusting, and 
itching. The disease may present a great variety of appear- 
ances, according to the locality involved and the duration and 
severity of the inflammation. It may bear a resemblance to 
nearly every other skin affection, but in most cases, especially in 
childhood, the disease is readily recognized. Unlike many other 
cutaneous affections, it has no characteristic lesion, but may be 
erythematous, papular, vesicular, or pustular at the outset and 
gradually become crusted, scaly, fissured, or ulcerated. As re- 
gards the grade of inflammation, the disease may be observed in 
an acute, subacute, or chronic form, and as regards duration it 
may in one case be insignificant and ephemeral while in another 
case it may persist or recur year after year. 

A multitude of adjectives have been applied to the numerous 
and varied clinical forms of eczema, and are useful for purposes 
of description, but the main thing for the physician to learn is 
to recognize the eczematous nature of the eruption, and to re- 
member that different clinical forms may coexist upon different 
portions of the body and that one form is very likely to develop 
into another as the eruption becomes better or worse. 

Eczema in childhood, as in later years, may occur in either 
an acute or chronic form. These terms, as commonly used, 
indicate the grade of inflammation rather than the length of 
time which the eruption has existed. In the acute form there 
is much redness, heat, and swelling, while in the chronic form 



42 



SKIN DISEASES OF CHILDREN. 



there is usually more thickening of the skin. An acute eczema 
often runs a typical course, which may be divided into three 
stages. These are, first, the stage of congestion and vesicu- 
lation; second, the stage of moisture and crusting; and third, 
the stage of desquamation. The vesicular condition is always 
transitory, and in many cases is not present. The effusion of 
serum may be so intense as to loosen and wash away the epi- 




Fxo. 21.— Eczema squamosum. 

dermis in a mass, thus leaving the typical raw, red, exuding 
surface; or, on the other hand, the serous effusion may be so 
slight as not to appear upon the surface, and the eruption 
passes directly from the congestive into the squamous stage. 
The outbreak of acute eczema is attended by more or less fever 
and restlessness. Repeated exacerbations often characterize 
the course of a chronic eczema, during which the eruption as- 
sumes an acute form. 



ECZEMA. 43 

There are four types of eczema which it is well to differenti- 
ate and of which a brief description may be given. The first is 
erythematous eczema, in which redness and slight scaling are 
the chief features. It is usually a dry and mild form of the 
disease, and was formerly described as a distinct affection under 
the name of pityriasis. It is frequently seen upon the face and 
hands of children, and appears like a roughened or chapped con- 




Fig. 22.— Eczema squamosum. 



dition of the skin. About the genitals and wherever folds of 
skin are in apposition it is apt to follow the affection known as 
erythema intertrigo, and in many cases, indeed, it is difficult to 
distinguish between the two, as one gradually develops from the 
other. In erythema we have simply congestion of the skin, 
while in eczema erythematosum there is a slight thickening 
from serous infiltration of the cutaneous tissues and a tendency 



44 



SKIN DISEASES OF CHILDREN. 



to the development of a moist surface when the skin is scratched 
or rubbed. Neither papules nor vesicles are present in this form 
of the disease. The eruption is usually limited in extent, 
although it may occur acutely in the form of numerous small, 
rounded or oval patches scattered over the face, trunk, and ex- 
tremities (Figs. 21 and 22). 

In the erythematous eczema of childhood itching is not apt 
to be severe, although in adults this form occurring upon the 




Fig. 23.— Eczema rubrum. 



forehead, about the eyes, and elsewhere is apt to produce con- 
siderable thickening of the skin and a most intolerable pruritus. 

In papular eczema, which was formerly described under the 
head of lichen simplex, we find irregular groups of bright-red, 
acuminate papules, many of which become excoriated and 
tipped by a minute blood crust, and some of which tend to run 
together, when sufficiently numerous, and form a thickened, 
scaly, or crusted patch. The accompanying plate shows a 
well-marked case of this form of the disease. 

Vesicular eczema is a form rarely met with, since the natu- 



ECZEMA. 



45 



ral duration of a vesicle rarely extends over a few days, and 
the itching which accompanies the eruption is certain to cause 
the lesions to be torn and the surface to become crusted by the 
drying of the serous exudation. And yet this aggregation of 
numerous minute, rounded, glistening vesicles upon a red and 
swollen surface of skin is perhaps the most characteristic 
phase of the disease. It was formerly believed that this was 
essentially a vesicular disease and that these lesions must be 




Fig. 24.— Eczema impetiginosum. 



present at the outset in every case of true eczema. The vesi- 
cular stage, when present, is attended with great heat and 
burning. The vesicles quickly rupture or coalesce, the epider- 
mis cracks, and a surface exudation of a clear serum takes 
place. This is of a mucilaginous character, stiffens hair or 
linen with which it comes in contact, and dries like a varnish 
upon the inflamed surface, which quickly cracks, however, 
and thus allows the discharge to ooze out at many points. 
When the inflammation is very severe the greater portion of 



•±6 



SKIN DISEASES OF CHILDREN. 



the inflamed surface, instead of being crusted, appears swollen, 
moist, and of an angry red hue (eczema rub rum) (Fig. 23). 

Pustular eczema results from an inflamed surface of skin 
becoming infected by pyogenic cocci. The characteristic ooz- 
ing or "weeping" surface may gradually become purulent, 
and the exudation may dry into an extensive, thick, yellowish 
or honey-like crust (eczema impetiginosum) (Fig. 24); or a 
group of isolated follicular pustules or minute superficial ab- 
scesses may develop and become crusted, in which case the 




Fig. 25.— Eczema pustulosum. 

eruption bears a strong resemblance to contagious impetigo. 
This form of the disease is especially liable to occur in children 
of a strumous habit and among those who are not distinguished 
for their personal cleanliness (Fig. 25). 

The squamous form of eczema is secondary to one of the 
preceding types. Indeed, a more or less scaly condition of the 
skin is seen in every patch of eczema before recovery takes 
place, and this may be regarded as the final stage in the course 
of the eruption. The amount and persistence of the scaling 
depend upon the extent of the infiltration of the skin. The 



ECZEMA. 47 

desquamation in eczema is always slight as compared with 
psoriasis, and the margin of the scaly patch usually shades off 
gradually into the surrounding healthy skin, instead of being 
circumscribed and abrupt as is always the case in the latter 
disease. 

In the eczema of infancy, which is a very common and often 
a very obstinate affection, the face and scalp are usually affected, 
and frequently portions of the trunk and extremities suffer to 
a less degree. The characteristic tendency of the eruption to 
assume the moist form usually manifests itself, and the face 
appears either inflamed and angry or covered by dried exuda- 
tion in the form of yellowish or blackish crusts. The little 
patient often suffers intensely from the oft-recurring pruritus, 
rolling his head in vain attempts to alleviate it by rubbing the 
inflamed skin against his clothing, or, if old enough to use his 
hands, tearing the face and causing it to bleed by sudden, fierce, 
and unexpected dabs with his sharp finger nails. 

The cause of eczema might be discussed at great length and 
still little light thrown upon the subject, for it is certainly an 
obscure one. It may suffice to assert that improper food and 
imperfect digestion are the most frequent causes of the affec- 
tion as it is met with in infancy. 

Infantile eczema has usually nothing to do with the teeth. 
It often appears before teething begins, and a similar eruption 
may occur in old age when all the teeth are gone. Further- 
more, it is always amenable to proper treatment, whether the 
child has one or twenty teeth. When the process of cutting 
teeth interferes with the general health of an infant, it is possi- 
ble for the eruption to be indirectly aggravated by the condition 
of the gums, but in no case is "teething" ever to be regarded 
as the sole cause of eczema. 

The "coming-out" of eczema is never a source of thankful- 
ness, unless it happens to come out on some other baby than 
our own. We might be thankful if it were to come out in the 
baby's clothing, and it is about as likely to do this as it is to 
affect any of the internal organs. Eczema is essentially a dis- 
ease of the skin, and cannot be transferred to the brain or 
lungs any more than the ruddy glow of a healthy cheek can be 
" driven in." It is true that sometimes an ointment is applied 
to an eczematous scalp or face, the eruption quickly disappears, 
and shortly after the baby may die of brain or lung disease. 
This may appear at first thought as though the eruption had 
been driven in, but the facts admit of a more reasonable 



48 SKIN DISEASES OF CHILDREN. 

explanation. When from exposure to cold or some other cause 
an inflammation of the brain or lungs results, the blood flows 
in an unusual quantity to the affected organ, and any eruption 
upon the skin soon begins to fade and disappear. This, of 
course, takes place whether any ointment be applied or not. 
In such a case it might be said, with perhaps more truth, that 
the eruption has been drawn in, but it is evident that the dis- 
appearance of the skin disease is the result and not the cause of 
the internal inflammation. 

The common belief that a skin disease is the outlet of some 
poisonous or vicious material in the blood is quite erroneous, 
and, in the light of modern pathology, a most absurd idea. An 
eruption can never be justly considered as either useful or 
beneficial to a patient. When a physician is unable to cure a 
case of infantile eczema, it may serve a purpose to claim that 
the eruption is salutary and that its sudden removal by local 
applications would be liable to produce disastrous results. The 
truth, however, is as follows : An eczema ought always to be 
cured as speedily as possible. This can always be done without 
the slightest danger of any harm to other organs of the body. 
Physicians of the largest experience in the treatment of skin 
diseases will all agree upon this point, and the sooner the old 
idea of the metastasis or translation of eczema is given up, the 
better it will be for the health of future babies and for the 
comfort of those who have the care of them. 

In the treatment of eczema in infancy and childhood, it is 
well to remember that the disease is inflammatory in character, 
usually acute or subacute, and that our main object should 
therefore be to soothe the congested skin. If there were a law 
in this country prohibiting the use of any ointment save the 
officinal unguentum zinci oxidi, what a blessing it would be to 
children with acute eczema! As it is now, the physician is 
usually disposed to regard zinc ointment as little better than a 
domestic remedy, it being so well known. Familiarity with it 
has bred contempt. It will not do, he argues, for a man of his 
experience and reputation to prescribe so common and simple 
a remedy, and so he adds to it a little ichthyol and a little 
resorcin and a little carbolic acid, or possibly some one of the 
" new remedies" with which the general practitioner is usually 
familiar long before the specialist is willing to try them. The 
result is that the druggist is called upon to rub up a salve in 
which the bland, emollient character of the simple zinc oint- 



ECZEMA. 49 

ment is completely lost — a salve which is certain to irritate the 
delicata and inflamed skin and to aggravate the eruption. 

More than a quarter-century ago Erasmus Wilson decided, 
after years of experience, that in acute infantile eczema the 
best method of treatment was by laxative doses of calomel and 
the external use of zinc ointment. While not unmindful of the 
progress which dermatology has made during this time, and 
in face of the flood of new remedies which is constantly pouring 
int3 our drug market, I defy any one in dermatological or 
pediatric practice to lay down a general method of treatment 
which, in the average case of infantile eczema, is practically 
superior to the one suggested by Wilson. A little starch or 
talcum added to zinc ointment will stiffen it and cause it to 
dry upon the skin, and thus obviate the necessity of smearing 
cloths and holding them in place by a bandage or mask 
When a patch of eczema has ceased to exude and is in the final 
or squamous stage, a little oil of cade (one to five per cent) 
added to the zinc ointment or paste will greatly increase its 
efficacy in restoring the skin to a normal condition. 

The tendency of soap and water to aggravate a moist eczema 
and to nullify the best of treatment is now generally under- 
stood by the profession. Indeed, the knowledge of this fact 
often leads the physician to forbid bathing in cases of dry 
eczema, when a daily bath would tend to improve the condi- 
tion of the skin and benefit the patient. It is only in acutely 
inflamed and exuding eczema that water is necessarily inju- 
rious. 

The regulation of the diet in case of eczematous children is 
of the utmost importance, as here may generally be discovered 
the cause of the eruption. With children old enough to go to 
the table, and especially with those who are apt to get what- 
ever they cry for, a restriction of the diet to pure milk will 
often do much toward effecting a cure. It is very difficult to 
lay down dietetic rules of general application, for what will 
prove best suited to some children will fail to agree with many 
others ; but it is certain that whenever a judicious local treat 
ment appears to have little effect upon the eruption, the closest 
attention to the diet and condition of the stools becomes imper- 
ative. In many cases the local treatment which has produced 
no beneficial effect will work like magic as soon as the bowels 
are freely opened and the digestion improved. 

The administration of arsenic, antimony, and other powerful 
4 



50 SKIN DISEASES OF CHILDREN. 

drugs may possibly do good in certain cases, but as I have 
seen arsenic, at least, do harm in a score of cases for every one 
in which I have seen it do good, I have no hesitancy in dis- 
pensing with their use in treating eczema in infants and young 
children. Arsenic should certainly never be given in the 
acute eczema of childhood nor during the exacerbations of the 
chronic form„ 




PAPILLOMA LINEARE. 



From the collection of photographs of 
Dp GEORGE HENRY FOX. 



PAPILLOMA LINEAEE. 



The affection of the skin to which attention is now briefly 
called under the name of linear papilloma is somewhat rare and 
is described in the text books of dermatology under a variety of 
titles. It is frequently congenital, often develops in childhood, 
but may first appear in later life. It is characterized by warty 
excrescences, either colorless or pigmented, occurring in small 
groups running in one or more lines for some distance over the 
surface of the skin and frequently appearing upon only one side 
of the body. The neck, trunk, or one of the extremities may be 
the seat of the disease, and in rare cases the greater portion of 
the body may be affected. In congenital cases the warty out- 
growth is apt to be fibrous and tough, while in cases developing 
later in life the lesions are softer, sometimes slightly scaly, and 
far more amenable to treatment. In some cases they have been 
known to disappear spontaneously or after some cutaneous 
exanthem, but a tendency to reappear upon the same site is 
usually manifested. 

Of the names which have been applied to the affection the 
following may be mentioned : ichthyosis hystrix seu localis, 
ichthyosis linearis neuropathica, nsevus verrucosus, nsevus unius 
lateris, nerve naevus, and papilloma neuroticum. 

The dark, fissured masses sometimes observed about the 
elbows and knees in severe cases of ichthyosis bear some re- 
semblance to the warty lines seen in this affection, but they are 
simply accumulations of epidermis and not papillomatous in 
character. In linear papilloma, however extensive it may be, 
there is nothing suggestive of ordinary ichthyosis, and the state- 
ment made by some writers that a xerodermatous or parchment- 
like condition of the skin often coexists with papillomatous 
streaks is by no means in accord with my experience. The 
disease in question might be classed with ordinary verruca 
(warts) more justly than with ichthyosis. 



52 



SKIN DISEASES OF CHILDREN. 



The term nsevus verrucosus would be applicable to this affec- 
tion, but the fact that this name is commonly applied to the 
soft, flattened, pigmented, warty outgrowths so frequently seen 
upon the backs of old men and women renders its use objection- 
able in case of the disease under consideration. Nsevus unius 
lateris is descriptive of most cases of this affection, but the fact 
that it may occur on both sides in certain cases may cause the 
name to sound absurd at times. 




Fig. 26.— Linear papilloma. 



The papillomatous streaks of this disease (like zoster) run 
transversely upon the trunk and longitudinally upon the extrem- 
ities. They run in the direction of the natural cleavage lines 
of the skin, and, though they usually appear to follow the cuta- 
neous distribution of certain nerves, they do not always do this 
with any great degree of accuracy. It would seem, therefore, 
that the name of linear papilloma as a descriptive title was pre- 
ferable to the term nerve naevus or papilloma neuroticum. 



PAPILLOMA LINE ARE. 



53 



In the accompanying plate, illustrating a case presented to 
the New York Dermatological Society by Dr. Cutler, the linear 
character of the affection is plainly shown in the streak coursing 
down the thigh and leg. In Fig. 26 the verrucous surface of 
the patch is quite apparent, while in Fig. 27 is seen the ten- 
dency of the lesions to form a broad, pigmented, warty patch in 
the axilla, from which a single line runs down the inner surface 
of the arm. 




Fig. 27.— Linear papilloma. 

The treatment of linear papilloma consists in the use of 
agents which tend to destroy or remove the excrescences. In 
cases of recent development, where the lesions are soft, the 
repeated application of a saturated solution of salicylic acid in 
collodion will act as effectively as it usually does in the case of 
corns and warts, and will soon leave the affected skin in a nor- 
mal condition. In cases of longer standing it is advisable to 
use the curette, and where the eruption is extensive to remove 



54 SKIN DISEASES OP CHILDREN. 

small portions of it at a time. But in certain cases, especially 
those which have existed since birth, the lesions are apt to be 
of such a dense fibrous character that the curette is of little 
use, and their removal is best effected by means of the curved 
scissors. It is doubtful whether any internal remedy is capable 
of affecting the growth in any notable degree. 



Plate VIII. 





Naevus pilosus. 

From the collection of Photographs of Dr. George Henry Fox. 



U^EYI, PIGMENTED AND HAIET. 



The term nsevus signifies a spot or blemish upon the skin. 
It is usually a congenital affection, although certain forms of 
skin disease to which the term nsevus is commonly applied may 
occur in youth or later in life. Many nsevi, especially of the 
pigmented and hairy variety, exist at birth, but are almost im- 
perceptible, and only become noticeable when they develop, as 
they are apt to do, after the age of puberty. 

The term nsevus includes affections of widely different patho- 
logical character in which hypertrophy is the only common ele- 
ment. They may be classed as fibrous, pigmented, hairy, and 
vascular nsevi. The fibrous or hypertrophic nsevus frequently 
occurring upon the face in the form of a small, rounded, and 
non-pigmented tumor or mole is peculiar to adult life, but the 
pigmented and hairy forms of nsevus are common in childhood 
and often require treatment at an early age. 

ISTsevus pigmentosus is the result of an excessive deposit of* 
pigment granules in the mucous layer of the skin. It differs 
from a freckle or chloasmic discoloration (which are acquired 
affections and liable to disappear spontaneously) in appearing 
at or soon after birth and being permanent. The pigmentary 
nsevus varies greatly in color and size. It may be yellowish or 
of a deep-brownish hue. It may be no larger than a pin's head, 
in which case it is apt to be multiple, Or it may cover a portion 
of the body larger than the hand. The face, neck, and back of 
the hand are favorite sites, but it may appear on the trunk and 
extremities. It is sometimes flat and smooth, like a freckle, but 
may become elevated and warty in certain cases, when the 
term nsevus verrucosus is applicable. 

In many cases of extensive pigmentary nsevus, whether smooth 
or elevated, we find a growth of fine or coarse hair upon the 
surface. When this is more marked than the pigmentation 
the affection is called nsevus pilosus. The hairy nsevus is often 



5G 



SKIN DISEASES OF CHILDREN. 



a small oval patch (as in the plate), and from its size and shape 
its origin is frequently ascribed to some maternal impression — 
e.g., the mother having been frightened by a mouse. Often 
the hairy scalp appears to extend over the temple or upon one 
side of the forehead, as in Fig. 28, and not infrequently it is seen 




Fig. 28. 



upon the cheek beneath the eye or involving both lids and 
vicinity, as in Fig. 29. 

In rare cases a large extent of cutaneous surface is affected, 
and the whole trunk may appear as though covered with fur 
instead of normal skin (Fig. 30). The lumbar or pelvic region 
is also apt to be the seat of the hairy nsevus, which in some cases 



NJEVI, PIGMENTED AND HAIRY. 57 

has suggested a resemblance to "bathing-tights/' The con- 
genital growth rarely increases in extent, except as the bod}' 
grows larger, but often the pigmentation becomes more pro- 
nounced and the hair begins to grow coarser in adult life. The 
development of small hairy moles upon the face of elderly 




Fig. 29. 

women, especially those suffering from hypertrichosis, is very 
frequently noted. 

In the treatment of the pigmentary mole, acids or the electro- 
lytic needle may be employed. For small, round, dark spots on 
the skin a minute drop of nitric acid, applied with a wooden 
toothpick, will often suffice to remove the blemish. In case of 
larger pigmented patches, either smooth or covered with fine 
hair, the surface of the skin may be dotted with the acid ; but 



58 



SKIN DISEASES OF CHILDREN. 



extreme caution must be used to prevent ulceration, lest scars be 
left which would be far more disfiguring than the nsevus itself. 
With children old enough to bear a little pain without crying, 
the pigmented spots may be blistered by touching them with 
the point of the electrolytic needle or by passing it superficially 
through the epidermis. 

In nsevi of small or moderate size covered with coarse hair 




Fig. 30. 

the electrolytic needle may be used, as in the treatment of hy- 
pertrichosis, and a fine result attained through patience and 
perseverance. In the Journal of Cutaneous Diseases for 
May, 1893, the writer has reported a case of extensive hairy and 
verrucous naevus involving the right cheek and lower eyelid, 
"which was completely removed by means of electrolysis. The 
treatment consisted in carefully passing a fine, flexible steel 



K3EVI, PIGMENTED AND HAIRY. 59 

needle, connected with the negative pole of a galvanic battery, 
through the most superficial portion of the growth, the circuit 
being completed by the patient grasping a moist sponge at- 
tached to the positive electrode. This was repeated until the 
electrolytic destruction of tissue reduced the growth to the level 
of the surrounding skin, removed the pigmentation, and to a 
certain extent destroyed the hypertrophied hair follicles. The 
slight growth of hair which persisted after the affected skin had 
become smooth and comparatively normal in color was de- 
stroyed by the introduction of the electrolytic needle into each 
separate follicle, according to the method employed in the treat- 
ment of superfluous hair. The young man now presents not 
the slightest deformity of the eyelid, and scarcely a trace, upon 
close inspection, of the dark, warty, and hairy growth which 
formerly attracted attention wherever he went and was the 
source of great mortification. 



PLATE IX. 





Vascular Naevus. 

From the collection of Photographs of Dr. George Henry Fox 



VASCULAR NJEVTTS. 



The vascular form of nsevus results from an excessive devel- 
opment of vascular tissue in or beneath the skin, and presents a 
variety of clinical appearances. These may be conveniently 
classified as follows : 1, nsevus araneus ; 2, nsevus flammeus, 
or port- wine mark ; 3, nsevus tuberosus ; and 4, nsevus caver- 
nosus. Of the many descriptive names which have been more 
or less in use, these appear to best express the characteristic 
features of the four clinical varieties of vascular nsevus. 

Nsevus araneus consists of a small red spot, smooth or slightly 
elevated, from which several dilated capillaries radiate like the 
legs of a spider. It has sometimes been called " spider cancer," 
a name which is as alarming as it is inappropriate. It is not 
always congenital, but frequently appears in youth or adult life 
as the result of a prick, bruise, or other injury to the skin. On 
this account some writers class it under the head of telangiec- 
tasis or acquired vascular dilatation, assuming that the term 
nsevus signifies a birthmark and not merely a spot or blemish. 
It is most frequently noted upon the upper portion of the face, and 
upon a fair white skin may be quite conspicuous and annoying. 

Nsevus flammeus, birthmark or port-wine mark, as it is com- 
monly called, usually appears as a smooth, red discoloration 
upon one side of the face. It varies greatly in size, often ex- 
tending down upon the neck and involving a considerable por- 
tion of the trunk. It varies also in color from a light pink to a 
deep purplish-red or even slate-colored hue. In its severe form 
the affected skin is elevated, the lip greatly swollen, and one side 
of the face may appear notably larger than the other. The dark 
surface of the skin may be dotted here and there in some cases 
by small vascular excrescences. At birth small, faint red 
marks may be noted, especially upon the lower portion of the 
occiput, which tend to disappear in later years, but the port- 
wine mark usually persists throughout life, either remaining 
unchanged or becoming more conspicuous. It has been claimed 



62 



SKIN DISEASES OF CHILDREN. 



that some cases have increased in area and that others have 
gradually disappeared, leaving atrophic scars, but such cases 
are notable exceptions to the rule. 

Nsevus tuberosus is a turgescent tumor of varying size with 
a rounded or flattened surface. It results from a congenital 
dilatation or new formation of blood vessels, and in color varies 
from a bright cherry-red to a purplish-red or leaden hue, ac- 
cording to the predominance of arterial or venous blood in the 




Fig 



-Nsevus of nose. 



tumor. It is frequently seen upon the scalp and face, although 
it may be found upon the trunk and extremities. It usually 
increases somewhat in size during the early months of infancy, 
and in some cases develops with such alarming rapidity that 
vigorous treatment is called for without delay. The tumor is 
usually elastic and compressible, and often varies in size and 
color at different times of day, and is especially prominent after 
a fit of crying or severe coughing. A distinct pulsation may 



VASCULAR N^EVUS. 



63 



"be sometimes felt, corresponding in rhythm with the action of 
the heart. Ulceration of the central portion of the surface oc- 
casionally takes place, and from this cause or from some acci- 
dental injury severe hemorrhage may result. Gangrene may 
occur and produce a spontaneous cure. 

Nsevus cavernosus is a deep-seated form of angioma over 
which the raised skin may appear of normal hue or present a 
dull-bluish or venous appearance. The tumor is formed by 




Fig. 32.— Birthmark of unusual extent. 

masses of dilated veins and arteries surrounded by firm con- 
nective tissue, which extends into the interior and forms vas- 
cular cavities communicating freely with the enlarged vessels. 
In some cases a number of these tumors, of varying size but of 
the same character, will extend along the surface of the skin 
like deep varices. They are usually soft, especially when of 
large size, and have a peculiar lobulated feeling when pressed 
beneath the fingers. 



64 



SKIN DISEASES OF CHILDREN. 



In the treatment of nsevus araneus and other telangiectases 
the electrolytic needle is most serviceable. Any form of gal- 
vanic battery may be used, and the point of an ordinary cam- 
bric needle or flexible steel jeweller's broach, attached to the 
negative cord, should be pressed into the centre of the red spot. 
A moist sponge attached to the positive cord should now be 
grasped in the patient's hand or slowly applied to the skin at 
any point, when the electrolytic current will begin to act and 
quickly produce a whitening of the skin around the needle 




Fig. 33.— Naevus of scalp. 

point and cause sufficient inflammation to seal up the deep- 
seated supply vessel. The pain caused by this operation is 
slight and no more than the promise of some candy or a coveted 
toy will induce the average child to endure. The result is 
always excellent. 

The electrolytic needle may also be used with success in 
many cases of port- wine mark, but the treatment is tedious and 
only capable of producing good results when persistently and 
skilfully employed. The best that can be said of it is that in 



VASCULAR N^EVUS. 



G5 



case of extensive and dark-hued patches it is superior to any 
other plan of treatment, even if it is not productive of the 
speedy and brilliant result which might be desired. The ob- 
ject of this method of treatment is to cover the dark-red skin 
with minute punctate cicatrices, which will at least lessen the 
conspicuous character of the mark, if it does not remove it 
entirely. To remove a red birthmark and leave a perfectly 
normal skin is an impossibility. In cases where the color is not 




Fig. 34. — Naevus tuberosus. 

very deep a good result may be obtained by dotting the surface 
with minute drops of nitric acid, great care being taken that 
these do not spread or run together and in this way produce 
ulceration and subsequent pitted or raised cicatrices. 

In the tuberose variety of nsevus, where red tumors sug- 
gestive of a strawberry, cherry, or flattened tomato are to be 
removed, a resulting cicatrix is unavoidable, and either acids, 
electrolysis, or the platinum cautery may be advantageously 

used. The size and disfiguring character of the scar which is 
5 



66 



SKIN DISEASES OF CHILDREN. 



necessarily produced will depend in great measure, however, 
upon the skill and caution displayed in the treatment, whatever 
means may be employed in destroying the vascular growth. 
The attempt to remove this form of nsevus by compression has 
always failed, in my experience; and as for ethylate of sodium, 




Fig. 35.— Nasvus of vulva. 



although it has proved successful, it has been quite as painful 
and less effective than nitric acid. 

In the treatment of the cavernous nsevus the knife, ligature, 
galvano-cautery, and injections of carbolic acid and of iodine 
have been recommended, and the most suitable method of 
treatment must depend upon the nature of the case. 



PLATE X. 




Lapus Vulgaris. 

From the collection of Photographs of Dr George Henry Fox. 



LUPUS AND OTHER TUBERCULIDES. 



Many years ago the fact was noted by dermatological clini- 
cians that lupus vulgaris was frequently associated with pul- 




Fig. 36.— A group of tubercles. 



monary phthisis, and recent microscopical research has demon- 
strated that in both affections the same bacillus may be found. 
Lupus vulgaris is therefore one of the clinical forms of cutane- 



68 



SKIN DISEASES OF CHILDREN. 



ous tuberculosis and may be properly described as a tubercu- 
lide. There are other affections of the skin which are commonly 
associated with the varied symptoms of scrofula and in which 
the bacillus tuberculosis may be found, but they are clinically 
distinct, though pathologically related to lupus. The term 
tubercular, as applied to lupus, was originally used only in a 
morphological sense, indicating the nodular character of the 
eruption. It is a singular fact that, while the old term is still 




Fig. 37.— Tubercles forming a ring. 



retained in use, science has invested it with a deeper and more 
definite significance since the discovery in the nodule of the 
tubercle bacillus. 

Lupus vulgaris is an affection which is often seen in child- 
hood, and which, indeed, begins in most cases before the age 
of puberty. It usually appears in the form of one or more dull 
red papules upon the cheek or elsewhere. These slowly increase 
in number and tend to coalesce (Fig. 36). Frequently the older 
or central lesions disappear by interstitial absorption and an 



LUPUS AND OTHER TUBERCULIDES. 



69 



irregular ring is formed (Fig. 37), or an infiltrated patch with 
one or two outlying nodules (see plate). Upon the neck the 
disease often assumes a serpiginous form, spreading at the 
margin and enclosing a cicatricial area, dotted, perhaps, by a 
few recently developed nodules (Fig. 38). This form of the 
disease may have a somewhat acute character, and, though 
spreading slowly, may increase in extent much more rapidly 
than does the nodular form seen upon the cheeks. 

Upon the ala nasi, which is a frequent site of lupus, a scaly 




Fig. 38.— Serpiginous lupus with central cicatrix. 

or crusted patch is often seen, with more or less ulceration, and 
in time a marked deformity as the result of cicatricial contrac- 
tion (Fig. 39). 

The nodules of lupus, when well developed, have a charac- 
teristic translucent, jelly-like appearance, and, though feeling 
firm and resilient to the touch, are much softer than the normal 
cutaneous tissue. In an advanced stage the nodules and 
patches of lupus become somewhat scaly and not infrequently 
soften and ulcerate. In chronic cases seen in adult life the 



70 



SKIN DISEASES OF CHILDREN. 



disease is often found to have spread over the greater portion 
of the face, producing a marked ectropion and a partial disap- 
pearance of the nose and ears. Such an extensive development 
of the disease is rarely if ever observed in childhood. Although 
the face is the most common site of lupus, the trunk and ex- 
tremities may also be affected, either independently or with the 
face. 




Fig. 39.— A favorite site of lupus. 



Another tuberculide, or affection in which the bacillus tuber- 
culosis is invariably present, is often met with in childhood as 
well as in adult life, and is known as tuberculosis verrucosa or 
lupus verrucosus. This consists of dry, warty, or papillomatous 
patches (Fig. 40), which may develop upon the back of the hand, 
especially over the knuckles, the wrist, the popliteal spaces, and 
other portions of the body, and is commonly regarded as the 
result of local infection. The development of the disease is 



LUPUS AND OTHER TUBERCULIDES. 



71 



slow. Ulceration rarely occurs, but the centre of the patch 
may undergo a spontaneous cure, leaving cicatricial tissue. 

Still another form of cutaneous tuberculosis is that commonly 
described under the name of scrofuloderma. This appears in 
the form of suppurating or crusted ulcers of the skin in chil- 
dren who usually present other evidences of the scrofulous 
taint. It is most frequently observed upon the neck over 




Fig. 40. — Lupus verrucosus (tuberculosis verrucosa cutis). 



lymphatic glands which have undergone caseous degeneration 
and softening, although it may occur in multiple discoid lesions 
over the buttocks, thighs, and other portions of the body. 
When lupus or scrofuloderma attacks the hand or fingers of a 
child the bony tissue is frequently involved and a strumous 
dactylitis may develop, or caries with resulting atrophy and a 
considerable subsequent deformity (Fig. 41). 



72 



SKIN DISEASES OF CHILDREN. 



Lupus erythematosus, though allied in name to lupus vulga- 
ris and often bearing a strong resemblance to it, cannot be 
considered as a tuberculide. The bacillus tuberculosis has not 
been found in this affection, and all attempts at inoculation of 
animals have given negative results. It may be remarked in 
passing that this disease, like lupus vulgaris, is most commonly 
seen upon the face (Fig. 42), but, unlike the common form of 
lupus, it is rarely seen in childhood. 




Fig. 41. — Ulcerating lupus with atrophy of bone. 



In the treatment of lupus and the other tuberculides much 
may be done to improve the general health of the patient and 
thus to modify to a limited extent the spread of the disease; 
but to effect a cure a resort to surgical measures is necessary. 
The palliative treatment by means of ointments and plasters, 
so frequently employed, need only be mentioned for the sake of 
condemnation. The morbid tissue must be destroyed, and it 
matters little how this is done provided it is thoroughly done. 



LUPUS AND OTHER TUBERCULIDES. 



73 



The knife, the cautery, and caustic pastes I have used and dis- 
carded, believing that by the skilful use of the curette and burr 
the disease can be removed with the least amount of pain and 
discomfort and the least resulting disfigurement. For many 
years I have used the dental burr of varying size, dipped in 
carbolic acid, for the destruction of lupus nodules, and ever with 
increasing satisfaction. This instrument readily penetrates the 




Fig. 42.— Lupus erythematosus. 



gelatinous lesions, and when the handle is rolled between the 
fingers, and the burr pressed in various directions, it bores out 
the softened lupus tissue as it does the carious substance in a 
dental cavity and leaves the normal skin uninjured. In dif- 
fused patches of lupus, in scrofulous ulcerations, and in verru- 
cous tuberculosis (after the warty surface has been removed by 
a salicylic-acid plaster) nothing can be more serviceable than 
the dermal curette. 




Lichen ruber 
/"Pityriasis rubroi pilar is J 









LICHEN KUBEE AND LICHEN PLANUS. 



Lichen ruber, or pityriasis rubra pilaris as it is called by 
many writers, is a rare disease, but one which is liable to affect 
children as well as adults. It is a chronic and obstinate dis- 
ease, in which the lesions are small, reddish, acuminate papules, 




Fig. 43.— Papular form of lichen ruber. 



usually seated at the orifice of hair follicles. These do not 
increase in size, but by multiplying and coalescing produce 
patches covered by fine, whitish scales and characterized by an 
exaggeration of the natural furrows of the skin. 



76 SKIN DISEASES OF CHILDREN. 

The eruption often undergoes a spontaneous improvement, 




Fig. 44.— Papules on a favorite site. 




Fig. 45.— Plantar lichen ruber resembling eczema. 

but only to relapse, and, as a consequence of this, its clinical 



LICHEN RUBER AND LICHEN PLANUS. 77 

appearance varies greatly at different times and often upon 




Fio. 4fi —Lichen ruber resembling ichthyosis. 




Fig. 47.— Lichen ruber resembling psoriasis. 

various portions of the body. Three stages or clinical forms 



78 



SKIN DISEASES OF CHILDREN. 



of the eruption may be conveniently described as the papular, 
squamous, and rugous forms of the disease. 

In the papular form of lichen ruber (Figs. 43 and 44) the 
lesions are small, usually acuminate, and often tipped with a 
minute white scale. When of recent development they produce 
an appearance quite similar to cutis anserina or follicular 
keratosis. Upon the dorsum of the fingers there is often noted 
a group of follicles plugged with blackened epidermic scales, 
while upon the palms and soles a scaly condition is usually pres- 




Fig. 48.— Rugous form of lichen ruber. 



ent, closely resembling a chronic squamous eczema (Fig. 45). 
The papules often increase rapidly in number upon certain por- 
tions of the body, become flattened and scaly as they coalesce, 
and now present an entirely different aspect. 

In the squamous form of lichen ruber the eruption appears 
as white, scaly patches of varying size and form, and frequently 
bears a strong resemblance to ichthyosis (Fig. 46) or psoriasis 
(Fig. 47) . The eruption in this stage shows a marked tendency 
to occur in elongated, spindle-shaped, or band-like patches. 



LICHEN RUBER AND LICHEN PLANUS. 79 

At the margin of these squamous patches numerous isolated, 
white-tipped papular lesions may frequently be seen. The 
scalp is generally affected when the disease has existed for 
some time, and the face often presents an appearance sugges- 
tive of ichthyosis. 

In the rugous form or stage of the disease the affected por- 
tions of skin present a dull-red, leathery appearance, with slight 
scaling and deep parallel furrows (see plate and Fig. 48). Upon 
the hands the skin sometimes becomes shrivelled and drawn to 
an extent which seriously interferes with the motion of the 
fingers (Fig. 49), while the nails show marked evidence of mal- 
nutrition. In some cases nodular ridges are found at the bend 




Fig. 49.— Chronic form of disease. 

of the elbow, upon the pubes, and elsewhere, and present a 
moniliform or bead-like appearance (Fig. 50). 

Itching is commonly present, and often very severe and an- 
noying in advanced cases, and an exacerbation of the eruption 
is frequently preceded by an intense burning sensation. 

The prognosis in lichen ruber is an unfavorable one. Al- 
though the disease may yield to judicious treatment, and even 
improve spontaneously, a long series of relapses may be looked 
for, and a fatal termination be predicted in many cases. The 
reported cure of cases by French and German writers may be 
readily explained by their belief in the identity of lichen ruber 
and lichen planus. 



80 



SKIN DISEASES OF CHILDREN. 



From what has been said it is evident that the treatment of 
this disease must of necessity be palliative rather than curative. 
The improvement of the patient's general health by a hygienic 
and tonic regimen will usually accomplish more than the ad- 
ministration of arsenic or any other drug. Meanwhile the 
comfort of the patient can be greatly increased by baths and 
inunctions tending to soften the dry, harsh skin and to lessen 
the pruritus. 

Lichen planus is a disease which is entirely distinct in nature 




Fig. 50.— Moniliform lichen ruber. 



from lichen ruber, although the two affections have been con- 
sidered as clinical forms of the same disease by many European 
writers. This erroneous view has led to considerable confusion 
of dermatological literature. The typical lesions of lichen pla- 
nus are small, flattened, angular papules with a shining surface 
and a minute central depression. Those of lichen ruber, on the 
other hand, are usually acuminate, although in rare cases they 
may appear flattened and smooth. The eruption in lichen pla- 
nus commonly presents a purplish or lilac hue, which is very 



LICHEN RUBER AND LICHEN PLANUS. 



81 



characteristic and often serves as an excellent basis of diagnosis. 
The lesions are at first discrete, but show a marked tendency to 
coalesce and form irregular or reticulate patches of varying 




Fig. 51.— Lichen planus. 

size. The most common site of the eruption is upon the ante- 
rior aspect of the forearm and next upon the lower extremi- 
ties. It is often seen around the waist and sometimes upon the 




Fig. 52.— Lichen planus. 

genitals. In exceptional cases the greater portion of the trunk 
may be affected, and such cases are very apt to be confounded 
with lichen ruber. Upon the legs the patches are frequently 
G 



82 



SKIN DISEASES OF CHILDREN. 



roughened and pigmented, and present an appearance quite 
unlike the eruption seen upon the trunk and forearms. 

Lichen planus runs a variable course, some cases disappear- 
ing spontaneously and often unexpectedly after an existence of 
a month or two, while others will sometimes persist for many 
months in spite of the most approved method of treatment. 
The itching is often very annoying to the patient, but the 
general health is usually unimpaired, and, unlike lichen ruber, 
the disease never terminates fatally. 




Fig. 53.— Lichen planus. 



In the treatment of lichen planus arsenic is often of service, 
but in this, as in many other affections, it may do harm as well 
as good ; and when there is much irritability of the skin alka- 
line remedies will be found to be of much greater service. Of 
the various local remedies which have been highly recom- 
mended no one seems to have any special value in all cases. A 
mild carbolic or salicylic acid lotion may be advantageously 
used in acute cases, and the same increased in strength when 
the patches have assumed a chronic character. 



'm SO H 




Syphilis Hereditaria 

from the collection of photo graphs of 



VARIOUS SKIN DISEASES OF CHILDREN. 



Syphilis hereditaria. — When syphilis is transmitted from 
one generation to another it may result in the death of the foetus 
in utero, or in the development of an infantile eruption which 
either is present at birth or appears shortly after. In most 
cases it manifests itself within three months, and always 
during the first year. The eruption may be erythematous and 
appear as a general roseola, similar to the earliest eruption of 
acquired syphilis, or in the form of dull-red patches on the 
trunk and upon the palms and soles, which present a dry, scaly 
appearance quite characteristic of the inherited disease. About 
the mouth the skin is often dry and fissured, and on the but- 
tocks the patches are apt to become raw and even ulcerated at 
various points. In some cases the eruption assumes a papular 
character (see plate), and numerous yellowish-red and slightly 
scaly discs are seen upon the buttocks, thighs, and face, and 
occasionally over the greater portion of the body. In rare 
instances the papules are small, flattened, and shining, and 
present a strong resemblance to lichen planus. Pustular lesions 
of an ecthymatous character are sometimes present, especially 
in infants who are ill-nourished and poorly cared for. Bullous 
lesions are not infrequently seen upon the palms and soles and 
other portions of the body, and in fact are much more common 
than in the acquired disease of adult life. 

In connection with these early cutaneous manifestations a 
notable condition of malnutrition is usually observed, and cer- 
tain characteristic symptoms resulting from affection of the 
mucous membranes and the osseous structures. The nasal 
passages are often inflamed and obstructed by an accumulation 
of mucus. The larynx may be affected, giving rise to a pecu- 
liar hoarse cry. 

The prevention of hereditary syphilis is more important than 



84 SKIN DISEASES OF CHILDREN. 

its treatment, and the physician is often in a position to advise 
against the premature marriage of syphilitic patients, and 
thus prevent an amount of misery and suffering which he 
could never cure. 

In the treatment of infantile syphilis a half -grain or more of 
mercury with chalk may be administered three times a day, 
and a speedy improvement expected if the child is properly 
cared for. When irritability of the stomach and intestines is 
present it is advisable to adopt the plan of mercurial inunc- 
tions. A mass of mercurial ointment, the size of a small 
marble, should be spread upon a piece of flannel and bound 
around the trunk or thighs, its position changed from day to 
day to prevent excessive irritation of the skin. 

In treating mucous tubercles and superficial ulceration upon 
the buttocks and about the genitals, calomel powder mixed 
with three to five parts of starch may be sprinkled over the 
raw surface, care being taken to keep the affected parts dry and 
clean. The importance of fresh air and nutritious food must 
never be forgotten, and when the symptoms of the disease 
have abated the syrup of iodide of iron, and perhaps cod-liver 
oil, may usually be given with great benefit. 

Erythema nodosum is one of the forms of erythema mul- 
tiforme, though commonly described in dermatological text 
books as a distinct disease. It occurs most frequently in child- 
hood, and the female sex seems especially prone to suffer from it. 

The lesions in this affection are red, painful swellings, look- 
ing very much like recent contusions, and are most frequently 
seen over the tibise. They are usually associated with slight 
fever, considerable malaise, and in some cases with articular 
pains. Both legs are commonly affected, and rarely are the 
lesions found elsewhere. In some cases, however, the lesions 
are numerous and found upon the thighs as well as the legs 
(Fig. 54), and in rare instances the forearms may be affected. 
The lesions are at first of a bright-red hue, but soon become 
dull red or purplish, and usually disappear in a week or two. 
New lesions sometimes continue to appear and prolong the 
duration of the disease. The individual nodules usually last 
from eight to fourteen days. New nodules appear, as a rule, 
during the first two weeks, and the disease may therefore last 
from three to six weeks. In exceptional cases it may continue 
for months. 

The cause of erythema nodosum is obscure. Most patients 
appear to be in poor condition, and a rheumatic tendency is 



VARIOUS SKIN DISEASES OF CHILDREN. 



85 



sometimes noted. An examination of the blood will sometimes 
reveal the presence of malarial organisms. 

The eruption always tends to a spontaneous recovery and 
usually shows no disposition to recur. While no medicinal 
treatment is absolutely necessary, a saline laxative at the outset 
will often do some good, and may be followed by the admin- 
istration of salicylate of soda. 

Locally a lead-and-opium wash, or a lotion of zinc oxide in 
lime water, will tend to allay the burning pain or tenderness of 




Fig. 54.— Erythema nodosum. 

the lesions, which is often a distressing symptom, and rest in 
bed for a few days is desirable during the height of the attack. 

Purpura, or idiopathic hemorrhage into the cutaneous 
tissues, results from many causes and occurs in connection 
with various diseases. It is usually characterized by small 
petechial or larger guttate spots, which are at first of a bright 
claret hue, but which rapidly assume a dull-purplish color. 
The eruption is readily distinguishable from an erythema or 
any inflammatory exanthem, since the redness does not dis- 
appear under firm pressure of the finger. 

In purpura simplex the lesions are commonly symmetrical 
and seen upon the legs, but in children more frequently than 



86 



SKIN DISEASES OF CHILDREN. 



in adults the eruption may appear upon the thighs (Fig. 55) and 
other portions of the body. In a child suffering from whoop- 
ing cough I have seen the chest dotted with petechial spots. 
When the hemorrhage takes place in or around a hair follicle 
the lesions are apt to be elevated, and to this condition the term 
purpura papulosa has been applied. 

In mild cases of purpura simplex the lesions usually appear 
suddenly without other symptoms, and gradually fade away 




Fig. 55.— Purpura. 



in one or two weeks, unless a fresh outbreak occurs. In this 
event the bright-red color of the recent spots contrasts strongly 
with the dull livid hue of the older lesions. 

In severe cases of purpura the eruption may be very abun- 
dant, and with the cutaneous lesions hemorrhage from various 
mucous surfaces may occur. The gums are usually swollen 
and bleed easily. . Epistaxis is frequent and blood is often 
noted in the stools and urine. This form of the disease is 
called purpura hemorrhagica. It is characterized by marked 



VARIOUS SKIN DISEASES OF CHILDREN. 87 

constitutional symptoms, and the weakness resulting from a 
continued loss of blood sometimes leads to a fatal termination. 

Another form of the disease is associated with severe ar- 
thritic pains and the appearance of elevated purpuric lesions, 
especially in the vicinity of the affected joints. This is termed 
purpura or peliosis rheumatica. This affection usually runs 
a brief course, although a repeated onset of fever and rheu- 
matic pains, followed by cutaneous hemorrhages, may protract 
it for months. It commonly attacks those who have a rheu- 
matic tendency but are otherwise apparently well. 

There is little difficulty in the diagnosis of purpura, as the 
color of the lesions is characteristic and their hemorrhagic 
nature can be readily demonstrated by the pressure of the fin- 
ger. It is well to remember, however, that cutaneous hemor- 
rhage is not infrequently an accompaniment of the eruption in 
severe cases of the common exanthemata. 

In the treatment of mild cases of purpura, rest in bed, with a 
nutritious diet and administration of the tinctura f erri chloridi, 
is generally followed by a prompt recovery. In severe cases, 
especially of the hemorrhagic type, iron, turpentine, and ergot 
are commonly employed with good effect. Ergot may be given 
by the mouth or by hypodermatic injection. For the latter 
purpose a grain-of ergotin may be dissolved in warm water and 
glycerin, and injected with such frequency as the exigencies 
of the case may demand. 

Molluscum is a term which has been applied to two distinct 
affections having no pathological relation to one another. One 
is the molluscum fibrosum of older writers,- which is now com- 
monly designated as fibroma. The other is the molluscum con- 
tagiosum, which was first described by the English dermatolo- 
gist Bateman early in this century. The latter is a somewhat 
rare affection of the skin, but of much more frequent occurrence 
in childhood than in adult life. It consists of one or more small, 
flattened whitish tumors, varying in size from a pin's head at 
the outset to a split pea when fully developed. These little 
growths are sometimes pedunculated and usually present a cen- 
tral depression, from which a whitish substance can be readily 
pressed out. This looks like ordinary sebaceous matter, but 
under the microscope is found to contain certain oval corpuscles 
which are a characteristic of the disease. 

The tumors are commonly seen upon the face and neck, but 
may occur on various portions of the body. They are usually 
multiple, sometimes numerous, and, though unsightly, are 



88 



SKIN DISEASES OF CHILDREN. 



never the source of any particular discomfort. They develop 
slowly and last indefinitely. Each begins as a minute elevation 
of a whitish color, and gradually the flattened summit and 
umbilication develops. When of full size the walls are some- 
times traversed by fine blood vessels which give the tumor a 
pinkish appearance. 

The disease is often called molluscum contagiosum, and, 
though its contagious character is not always apparent, it has 




h "*te% !fc . 



Fig. 56.— Molluscum. 



m known to affect several in a family or in a ward of a 
children's hospital, and attempts at artificial inoculation have 
sometimes been successful. It is doubtless of microbic origin, 
but the conditions favoring its development are as yet obscure. 
It is especially liable to affect children of a poorer class, and 
hence is much more common in dispensary than in private 
practice. Damp and crowded dwellings seem to favor its devel- 
opment, and in dispensary practice I have known a number of 



VARIOUS SKIN DISEASES OF CHILDREN. 89 

cases to originate in the same locality. Children suffering from 
molluscum are especially prone to have warts upon the hands. 

The diagnosis of molluscum is usually made with ease by 
any one at all familiar with the appearance of the tumors. 
Large milia upon the face might be mistaken for them; but 
these tumors are rounded, of much firmer consistence, not 
likely to occur in groups, and always lack the characteristic 
flattened surface and central umbilication. 

The treatment of molluscum is simple and effective. Many 
of the tumors, after a duration of a few weeks or months, 
undergo a process of destructive inflammation, and a sponta- 
neous cure results. This is especially apt to be the case when 
two are close together and coalesce as they increase in size. 
If a tumor is vigorously compressed and the contents evacu- 
ated it will usually disappear. Incision and cauterization, or 
abscission by means of a sharp knife, have been recommended* 
but the simplest method of removing the tumors is to scrape 
them quickly with a curette and to lightly touch the bleeding 
surface with nitrate of silver. The main object in treating 
these tumors is to destroy them completely and to excite as 
little inflammation as possible in so doing. When even a large 
molluscum is removed by means of the curette no scar or trace 
of the growth is usually left, since the tumor is an outgrowth 
of the epidermis and does not involve the true skin. But when 
an inflamed molluscum is scratched or irritated to the extent 
of inducing a purulent secretion, a slight pit may be expected 
to result. 

Keratosis follicularis is an affection not infrequently seen 
in childhood, especially among children who are poorly cared 
for. It is the result of an abnormally dry condition of the skin 
and the accumulation of epidermic scales in the hair follicles. 
This produces an eruption of small, conical papules, which are 
commonly found upon the outer aspect of the extremities. 
These are usually of the color of the skin. Sometimes they 
are discolored by dirt, and in some cases they become inflamed 
and present a dull-red hue. The fine hairs growing upon the 
affected skin are often broken off or coiled up in the follicles. 
When the disease is severe and of several years' duration the 
skin has an ichthyotic appearance and to the touch feels like a 
nutmeg grater. The disease is described in some text books 
under the name of lichen pilaris or keratosis pilaris, but the 
follicle is primarily involved and not the hair. Recently the 
term keratosis follicularis has been applied by some writers to 



90 



SKIN DISEASES OF CHILDREN. 



an entirely different and extremely rare disease described by 
Darier. 

The treatment of the disease is mainly palliative, as in many 
cases time alone will effect a complete cure. The daily inunc- 
tion of the skin with some fat or oil, and the frequent resort 
to hot baths and vigorous soap frictions, will be productive of 
much benefit and often restore the skin to its normal condition. 




Fig. 57.— Keratosis follicularis. 



But this treatment must be continued for some time to prevent 
a return of the disease. A Turkish bath once or twice a week 
will prove of service. 

Keloid is a dense fibrous tumor of the skin, which in certain 
individuals is liable to develop upon the site of a cut, burn, or 
other injury. A distinction has often been made between true 
and false keloid, many writers claiming that the former develops 
spontaneously while the latter is always an outgrowth upon 



VARIOUS SKIN DISEASES OF CHILDREN. 91 

a scar. This distinction, however, is of little value, since the 
growth is the same in either case, and it is impossible to assert, 
in any case of spontaneous keloid, that it has not been preceded 
by some prick or slight injury to the skin. A distinction, how- 
ever, may be justly drawn between keloid and a hypertrophic 
cicatrix. Many scars, especially those following burns, are 
prone to pucker and bulge until a tumor is formed which looks 
very much like keloid, being rounded, smooth, reddened, and 
often very firm and even painful. But while keloid is charac- 
terized by a marked tendency to enlarge its area by the forma- 




Fig. 58.— Keloid. 

tion of claw-like processes suggestive of a crab, and to persist 
indefinitely, the hypertrophic cicatrix never extends beyond the 
limits of the scar tissue and tends to a gradual disappearance 
rather than to an increase in size. 

Keloid is usually single, but many tumors may be present, 
and in some cases these attain considerable size. The growth 
is commonly painful when squeezed or pressed, and sometimes 
a continuous burning or pricking sensation is experienced. A 
spontaneous disappearance of the tumors has been reported, but 
this is exceptional. Keloid occurs at all ages, affects various 



92 SKIN DISEASES OF CHILDREN. 

portions of the body in both sexes, and is especially common in 
the negro race. The tumors increase in size for a certain time 
and then often remain stationary for years. A characteristic 
peculiarity is their tendency to return quickly whenever excised. 
A spontaneous disappearance of keloid is more likely to occur 
in childhood than in adult life, and tumors developing upon 
large scars are more likely to disappear than those which seem- 
ingly spring from the normal skin. A favorite site of keloid is 
the sternal region, where it often appears in adults as an elon- 
gated flattened tumor crossing the median line in a transverse 
direction. Its frequent occurrence in this locality has been at- 
tributed to the common custom of applying blisters to this part 
for the relief of acute pulmonary affections. It also is seen 
frequently upon the scalp, face, neck, and trunk. 

The "treatment of keloid is usually discouraging. Excision, 
as has been remarked, is usually followed by a return of the 
growth. Good results have been obtained by deep linear scari- 
fication and the application of glacial acetic acid to the cuts, 
and also by the use of the electrolytic needle. Subcutaneous 
injections of thiosinamine have been recommended, and in 
hypertrophic cicatrica I have known this to be followed by 
benefit. The results from the subcutaneous use of this drug 
in lupus, psoriasis, and certain other skin diseases have not 
proved to be as beneficial as its enthusiastic advocates of a few 
years since were disposed to claim. But in the relief of corneal 
opacities and cicatricial contractions it has apparently proved of 
value. Whether its use in true keloid will effect even a notable 
improvement remains to be demonstrated; but in cases of scar 
keloid which are tending to recovery it might, at least, be 
tried in connection with the fatty inunctions and frequent mas- 
sage which seem to do some good and certainly 5 do no harm. 

Scabies is a disease which in this country has notably in- 
creased in frequency during recent years. In most cases it is 
readily recognized by the characteristic location of the excori- 
ated papules which mainly constitute the eruption. The dis- 
ease, as is well known, is due to the burrowing of the acarus or 
itch-mite in the soft skin between the fingers and elsewhere, and 
is usually communicated by sleeping with, or in a bed which 
has been occupied by, a person affected with the disease. The 
mature, impregnated female alone makes the burrow in which 
the eggs are deposited, and dies after performing this function. 
In recent cases the burrows or cuniculi in which the female 
acarus has deposited her eggs may be found upon the web of the 



VARIOUS SKIN DISEASES OF CHILDREN. 93 

fingers, the anterior portion of the wrist, the axillae, genitals, 
and ankles, and appear as small, curving dotted lines, from the 
extremity of which the insect may sometimes be dug out with 
the point of a needle. These burrows are often concealed by 
an eruption of vesicles, pustules, and crusted sores, and not 
infrequently the lesions of contagious impetigo are present. 
Upon other portions of the body the eruption usually consists 
of numerous excoriated papules covered by minute blood crusts. 
The anterior aspect of the forearms and the abdomen are espe- 
cially apt to be the seat of the eruption, but when the disease 
has existed for several months the eruption may cover the 




Fig. 59.— Scabies. 

whole body, with the exception of the face, which always re- 
mains unaffected, except in the case of infants and very young 
children. The location of the eruption in this disease depends 
to a great extent upon the character of the clothing which the 
patient wears, and differs in the case of men, women, and 
children. The excoriations about the breasts of women and 
upon the genitals of men and boys are due to the ease with 
which these parts can be scratched at night, while in young 
children who wear long, close-fitting night dresses the wrists 
and ankles are most likely to be the seat of the eruption. 

The treatment of scabies is simple and effective. For gene- 



94 



SKIN DISEASES OF CHILDREN. 



rations sulphur ointment has been a standard remedy, and 
nothing else is needed, although many other remedies and 
combinations have been recommended. A warm bath should 
first be taken to soften the skin, and soap used vigorously to 
remove the dead epidermis covering the cuniculi. The sulphur 
ointment should now be rubbed gently into the affected skin, 
especially in those regions where the acarus is apt to burrow, 






' -V. 




Fig. 60— Pustules in scabies. 



and this inunction repeated, without bathing, for about five suc- 
cessive nights. Under this treatment the itching is abated and 
the disease usually cured. In severe cases it may be necessary 
at the end of five days to repeat the bath and the subsequent 
inunctions. In infants and young children, or in patients with 
a very delicate skin, it is advisable to dilute the sulphur oint- 
ment with one or two parts of vaseline or cold cream. 



FORMULARY. 



Note. — In the following formulary the decimal system has 
been employed, and the percentage of each ingredient can 
therefore be readily seen at a glance. The unit may be re- 
garded as a grain, a gramme, or any other weight, without 
changing the relative amount of the ingredients. An excep- 
tion to this rule will be found in the baths recommended for 
syphilis, in which definite amounts are given in both the me- 
tric and the apothecaries' systems. The formulae have been 
carefully selected from the writings of various well-known 
authorities, and some trifling changes have been made in a few 
cases in order to reproduce the prescriptions in a decimal form 
or to render them more suitable for use in childhood. The signs 
3 , M. , and S. have been omitted to avoid repetition. As far as 
possible an attempt has been made to give due credit to the 
author of each formula. 

ACNE. 

1. 

Glycerini 3 

Alcoholis 20 

Sulphuris prsecipitati 30 

Aquae destillatae q. s. ad 100. 

To be used as a lotion. 

(Liveing.) 

2. 

Ichthyolis 10 

Alcoholis 50 

JEtheris q. s. ad 100. 

3. 

Spiritus lavandulae 3 

Saponis mollis 6 

Tincturae hamamelidis 10 

Alcoholis q. s. ad 100. 

Use to stimulate indurated spots. 



96 SKIN DISEASES OF CHILDREN. 

4. 

Acidi borici 3 

Aquae hamamelidis 40 

Aquae rosae fortioris q. s. ad 100. 

To be used in acne punctata. 

(Shoemaker.) 



5. 

Iodi 25 

Potassii iodidi 25 

Glycerini q. s. ad 100. 

Paint the surface with a brush twice daily for from three to six 
days. When the crust is cast off apply a simple ointment or 
powder. This is to be used in severe indurated cases only. 



6. 

Tincturae benzoini 2 

Glycerini 3 

Zinci oxidi 10 

Unguenti aquae rosae q. s. ad 100. 



7. 

Thymolis 1 

Oleati zinci 6 

Sulphuris sublimati ... 12 

Adipis lanae hydrosi q. s. ad 100. 



8. 

Europheni 6 

Unguenti zinci oxidi q. s. ad 100. 



Naphtolis , 2 

Sulphuris sublimati.. ...... 4 

Unguenti q. s. ad 100. 

(Kaposi.) 



FORMULARY. 97 

10. 

Hydrastininae hydrochloratis 1 

Zinci carbonatis 10 

Unguenti zinci oxidi q. s. ad 100. 



ALOPECIA AREATA. 

1. 

Acidi salicylici 3 

Sulphuris prsecipitati 15 

Petrolati mollis 45 

Adipis q. s. ad 100. 

Apply at night. Shampoo the head the next morning with a 
salicylated soap and apply friction with a soft brush, wet 
with the following: — 

Hydrargyri chloridi corrosivi 1 

Spiritus rosmarini 250 

Alcoholis q. s. ad 5 0. 

Once a week the patches may be painted with : — 

Spiritus gaultheriae 50 

JEtheris q. s. ad 100. 

(Feulard.) 



2. 

Acidi tannici 2 

Olei ricini 50 

Oleithymi q. s. 

Alcoholis absoluti q. s. ad 100. 

To be used as a head wash every evening. Once a week 
substitute the following: — 

Acidi salicylici 1 

Acidi acetici glacialis , 50 

Olei geranii q. s. 

Olei ricini q. s. ad 100. 

In addition to the above the head is to be washed once a 
week with soft soap. 

(Rochon.) 

7 



5 SKIN DISEASES OF CHILDREN. 

3. 

Tincturaa benzoini 1 

Acidi salicylici 2 

Alcoholis q. s. ad 100. 

Apply once or twice daily. 

(Kaposi.) 



4. 

Olei cinnamomi , 33 

iEtheris q. s. ad 100. 

(Gaucher.) 



5. 

Spiritus ammonise 15 

Extracti pilocarpi fluidi 30 

Linimenti saponis mollis q. s. ad 100. 

(Shoemaker.) 

6. 

Tincturse capsici 1 

Balsami Peruviani 2 

Alcoholis q. s. ad 100. 

(Kaposi.) 



7. 

Tincturse cantharidis 10 

Tincturae capsici 10 

Olei ricini 10 

Alcoholis diluti q. s. ad 100. 

(Ashby & Wright.) 

8. 

Acidi acetici 10 

Olei ricini 50 

Alcoholis q. s. ad 100. 



Acidi acetici glacialis 3 

Chloralis 4 

iEtheris q. s. ad 100. 

(Gaucher.) 



FORMULARY. 



10. 



Quininae 1 

Acidi tannici 2 

Olei resedae q. s. 

Olei aurantii florum q. s. 

Unguenti aquas rosae q. s. ad 100. 

To be used occasionally if hair is dry. 



11. 

Tincturae benzoini 2 

Hydrargyri ammoniati 5 

Olei rosse q. s. 

Unguenti aquae rosae q. s. ad 100. 

Pomade. To be used if hair is very dry. 

(Kaposi.) 

12. 

Chrysarobini 10 

Ceraa albae 30 

Adipis lanae hydrosi q. s. ad 100. 

For dispensary practice. 

13. 

Acidi salicylici 20 

Cerae albae 25 

Adipis lanae hydrosi q. s. ad 100. 

For dispensary practice. 

(Unna.) 



BITES AND STINGS OF INSECTS. 

1. 

Ammonii chloridi 10 

Alcoholis 10 

Aquae q. s. ad 100. 



Hydrargyri chloridi corrosivi 1 

Aquae q. s. ad 1000 



100 SKIN DISEASES OF CHILDREN. 



Naphtolis. 3 

Aquae q. s. ad 100. 

4. 

Potassii permanganatis 1 

Aquae q. s . ad 100. 

5. 

Aquae hydrogenii dioxidi , q. s. 

For local application. 

6. 

Aquae ammoniae fortioris q. S. 

Apply locally. 

7. 

Acidi borici 10 

Unguenti aquae rosae q. s. ad 100. 



BURNS. 

1. 
ANTISEPTIC CAGE TREATMENT. 

A cradle or raised surface is placed so that an antiseptic 
dressing covers the wound but does not come in contact with 
it. The wound is dressed by lifting the dressing and washing 
the surface with a weak antiseptic solution. 

(Benson.) 

2. 
LONDON HOSPITAL TREATMENT. 

A severely burned child is immediately wrapped in a blanket, 
without having its clothes removed. The bed is placed near a 
fire ; hot- water bottles are applied ; brandy and the tincture of 
opium are given. As the patient reacts, one part after another 



FORMULARY. 101 

is dressed with zinc ointment and covered with cotton. After 
the dressing the part is recovered with a blanket. Suppuration 
commences in about four days, and the parts are then redressed. 
It is at this period that diarrhoea is to be feared and should be 
treated at its inception. Never give aperients, but use enemata 
if constipation arises. In the interim, before the suppuration 
has commenced, the child is given two to three minims of the 
tincture of opium every four hours and one -half drachm of 
brandy every hour. The rule of never waking a child for its 
medicine is sufficient safeguard against an overdose. For a 
child two or three years old the first dose of the tincture should 
not be less than four or five minims, with two drachms of 
brandy, to be followed by three minims, if the child is crying, 
at the end of one hour. 

(Fenwick & Barnard.) 



3. 

WATER-BED TREATMENT. 

The patient is kept continually in Hebra's water-bed at a 
temperature agreeable to himself, and the wounds are treated 
surgically. The water is to be renewed two or three times a 
day. This bath can be imitated in private practice with a 
long bath tub, horsehair pillows, and blankets. 

(Hebra.) 



TREATMENT OF POWDER BURNS. 

Suppuration occurs in a few days. Apply wet compress for 
one-half of an hour or longer. A sharp razor is then passed 
over the surface, which cuts off the soft elevations containing 
the powder. Wash off with a stiff sponge moistened in a weak 
antiseptic solution. Clean and rewash until all coloring mat- 
ter is removed. 

(Coombs.) 



102 SKIN DISEASES OF CHILDREN. 

5. 
Potassii nitratis q. s. 

Add a few teaspoonfuls to a basinful of water. The part 
affected should be bathed for from two to three hours. If pre- 
ferred, compresses thoroughly wet with a saturated solution may 
be applied. The analgesic effect produced is due to the refri- 
gerant action of the salt. If the pain returns when the tem- 
perature of the water is raised, more of the potash should be 
added or the compresses renewed. 

(Poggi.) 



6. 

Sodii chloridi 1 

Aquae q. s. ad 100. 

Apply on compresses thoroughly wet with the solution. A 
window may be cut in the dressing through which the part 
may be kept constantly moist. 

(Keen.) 



7. 

Bismuthi subnitratis q. s. 

Aquae f ervidae s q. s. 

Mix to the consistency of a paste. Apply with a soft brush 
over the affected area. The bullae in burns of the second de- 
gree are drained with antiseptic silk, and the raised epidermis 
is allowed to remain in situ. The original covering is added to 
from time to time, as it cracks or falls off, but no other dressing 
is used. Magnesia may be used in the same way. 

(Osthoff.) 



8. 

Ichthyolis 6 

Zinci oxidi 30 

Cretae praeparatae q. s. ad 100. 

Apply once daily. 

(Leistikow.) 



FORMULARY, 103 



Acidi picrici 3 

Aquae q. s. ad 200. 

Immerse the affected part for five minutes and wrap in cot- 
ton, protecting it, if excoriated, with iodoform gauze. The 
stain can be removed with a solution of boric acid. 

{Thierry.) 



10. 

Tincturae opii 6 

Liquoris plumbi subacetatis 6 

Aquas hamamelidis 12 

Aquae q. s. ad 100. 



11. 

Sodii bicarbonatis 3 

Aquae , q. s. ad 100. 



12. 

fchthyolis 5 

Zinci oxidi 10 

Cretae praeparatae 20 

Amyli 20 

Liquoris calcis 20 

Olei lini q. s. ad 100. 

Apply once daily. 

(Leistikow.) 



13. 

Aristolis 5 

Olei olivse 20 

Sol. ad. 

Petrolati mollis 40 

Adipis lanae hydrosi q. s. ad 100. 



Do not apply until secretion ceases. 

(Haas.) 



104 SKIN DISEASES OF CHILDREN. 

14. 

Cocainae 1 

Sodii bicarbonatis 5 

Adipis lansB hydrosi 15 

Olei olivse q. s. ad 100. 

(Shoemaker.) 



15. 

Argenti nitratis 50 

Aquse destillatse q. s. ad 100. 

Nitrate of silver stick or this solution may be used to cauter- 
ize the exuberant granulations. The surface must first be 
moistened with a two per cent solution of cocaine. 



CHILBLAINS. 
1. 



Argenti nitratis 5 

Aquae q. s. ad 100. 

Use when itching is severe. 

2. 

Calcii chloridi 2 

Aquse , q. s. ad 100. 

Use when itching is severe. 

(Jacobi.) 

3. 

Talci 8 

Resorcini 15 

Mucilaginis acacise 40 

Aquae q. s. ad 100. 

Paint the surface. 

(Boeck.) 



FORMULARY. 105 

4. 

Iodi 1 

Potassii iodidi 3 

Glycerin! q. s. ad 100. 

Paint the surface. 

5. 

Tincturse iodidi , 1 

Olei ricini 5 

Collodii q. s. ad 100. 

Paint the surface. 

6. 

Plumbi acetatis 12 

Unguenti aquae rosae q. s. ad 100. 

(Kaposi.) 

7. 

Ichthyosis 25 

Adipis lanae hydrosi q. s. ad 100. 

For older children. 

(Hermane.) 



8. 

Capsici 6 

Olei amygdalae expressi 24 

Adipis lanae hydrosi q. s. ad 100. 

Rub in with a piece of flannel. 

(Ashby & Wright.) 



DERMATITIS GANGRENOSA. 

1. 

Hydrargyri chloridi corrosivi „ 1 

Aquae q. s. ad 500. 

2. 

Chloralis „ \ 

Aquae q s. ad 100. 



106 SKIN DISEASES OF CHILDREN. 

3. 

Acidi salicylici 2 

Aquae . . .q. s. ad 100. 

4. 

Acidi borici 20 

Talci 40 

Amyli q. s. ad 100. 

5. 

Acidi tannici 5 

Petrolati mollis q. s. ad 100. 



Salolis 4 

Petrolati mollis q. s. ad 100. 

7. 

Dermatolis 4 

Petrolati mollis q, s. ad 100. 

(Gaucher. ) 



DERMATITIS EXFOLIATIVA NEONATORUM. 

Hygienic measures, breast milk, and tonics constitute the 
general treatment. Protect the desquamating surface with 
cotton and by the application of oils and fats. An incubator 
should be used, if possible. 

(Ballantyne.) 



ACUTE ECZEMA. 

1. 

Iridis 5 

Zinci oxidi 5 

Alumini 20 

Amyli q. s. ad 100 



FORMULARY. 107 

2. 

Plumbi carbonatis 10 

Zinci oxidi 20 

Bismuthi subnitratis 20 

Talci 20 

Amyli q. s. ad 100. 

Apply with a powder puff to the exposed parts of the skin, 
and to the intertriginous folds on pledgets of cotton thickly 
covered with powder. Change the pledgets as soon as they 
become warm and moist. 

(Kaposi.) 



3. 



Zinci carbonatis 25 

Plumbi carbonatis 25 

Sulphuris sublimati 25 

Marantae pulveris q. s. ad 100. 



Amyli 30 

Plumbi carbonatis 35 

Lycopodii q. s. ad 100. 



5. 



Acidi tannici 1 

Bismuthi subnitratis 8 

Aquae rosse f ortioris „ q. s. ad 200. 



(Shoemaker. ) 



6. 



Plumbi acetatis 1 

Alumini 5 

Aquae destillatae q. s. ad 100. 

Dilute five times with water and apply on compresses. 



108 SKIN DISEASES OF CHILDREN. 

7. 

Acidi carbolici 1 

Spiritus lavandulae 20 

Spiritus odorati. . .. 30 

Alcoholis q. s. ad 200. 

Apply to the surface in case the pruritus is very severe. Fol- 
low immediately by the application of an inert powder. If 
there is not the slightest particle of moisture, tinctura rusci acts 
better. Apply in a very thin layer and follow with powder. 

(Kaposi. ) 



8. 

Zinci oxidi 10 

Glycerini 20 

Gelatini . . . 25 

Aquae destillatae q. s. ad 100. 

Cut off the quantity desired. Melt in a warm-water bath 

and apply with a brush. Only to be used when no moisture 

is present. 

(Kaposi.) 



9. 

Naphtolis 1 

Carnphorae 1 

Cocainae hydrochloratis 1 

Zinci carbonatis : 6 

Unguenti aquae rosae q. s. ad 100. 

Use in acute infantile eczema. 



10. 

Creolini 2 

Acidi borici 10 

Zinci carbonatis 20 

Marantae 20 

Adipis lanae hydrosi q. s. ad 100. 

Use in acute infantile eczema. 

(Shoemaker.) 



FORMULARY. 109 

11. 

Dermatolis 6 

Amyli 15 

Petrolati mollis q. s. ad 100. 

Use in the squamous stage. 



12. 

Zinci oxidi 20 

Amyli 20 

Adipis q. s. ad 100. 



Use in the squamous stage. 



13. 



Hydrargyri ammoniati 10 

Glyceriti amyli q. s. ad 100. 

Use in the squamous stage. 



14. 

Acidi tannici 5 

Adipis lanae hydrosi 30 

Petrolati mollis q. s. ad 100. 

Use in the squamous stage if disease threatens to become 
chronic. 

15. 

Olei cadini 10 

Petrolati mollis q. s. ad 100. 

Use in the squamous stage if disease threatens to become 
chronic. 

16. 

Acidi salicylici 2 

Amyli 8 

Zinci oxidi 10 

Adipis lanae hydrosi 15 

Petrolati mollis q. s. ad 150. 

Use in the squamous stage if disease threatens to become 
chronic. 

{Gaucher.) 



110 SKIN DISEASES OF CHILDREN. 

CHRONIC ECZEMA. 

1. 

Liquoris potassii arsenitis 3 

Syrupi aurantii florum 25 

Olei morrhuse , 50 

Mucilaginis q. s. 

Aquas q. s. ad 100. 

One teaspoonful three times a day, after meals, for a child 
less than one year old. 

(Ashby & Wright.) 



2. 

Syrupi f erri iodidi 20 

Extracti malti fluidi. q. s. ad 100. 

One-half teaspoonful to two teaspoonfuls three times a day. 

(Shoemaker.) 

3. 

Plumbi acetatis 2 

Aquae „ q. s. ad 100. 

Apply as a lotion. 

4. 

Alumini 3 

Aquae q. s. ad 100. 

Apply as a lotion. 



5. 

Argenti nitratis 5 

Aquae q. s. ad 100. 



Apply as a lotion. 



6. 

Acidi tannici 4 

Glycerini 50 

Aquae q. s. ad 100. 

Apply as a lotion. 



FORMULARY. Ill 

7. 

Chloralis 3 

Glycerini 50 

Aquae q. s. ad 100. 

Apply as a lotion when the area affected is small. 

(Gaucher.) 



Unguenti cum styrace 20 

Olei olivse q. s. ad 100. 

(Vidal) 



Zinci oxidi , 50 

Adipis lanaa hydrosi q. s. ad 100. 

In eczema universalis the child is covered from head to foot 
with soft cotton compresses thickly spread with the ointment. 
He is held in bed by broad straps drawn across his legs, ab- 
domen, chest, and shoulders, thus binding his arms to his side 
and keeping his legs in extension. Soft, heavily padded sand 
bags are placed one on either side of the head, to prevent any 
movement and consequent irritation. A nurse is in continual 
attendance at first, and soothing drugs may be given if neces- 
sary. 

(Botch.) 



10. 

Cretae prseparatae 3 

Sulphuris sublimati 15 

Olei fagi 15 

Saponis mollis 30 

Adipis q. s. ad 100. 

Apply thinly with a brush. 

(Hebra.) 



11. 

Olei rusci 1 

Zinci oxidi 5 

Petrolati mollis 50 

Adipis lanae hydrosi q. s. ad 100. 

(Baginsky.) 



112 SKIN DISEASES OF CHILDREN. 

12. 

Hydrargyri ammoniati 3 

Balsami Peruviani 15 

Unguenti zinci oxidi q. s. ad 100. 

(Saalfeld.) 



13. 

Olei cadini 25 

Petrolati mollis 25 

Adipis lanse hydrosi q. s. ad 100. 

The oil of cade should be pure and made from the wood. 
The coal-tar product is much inferior in its effect. 



14. 

Ichthyolis 10 

Petrolati mollis q. s. ad 100. 



15. 

Naphtolis 2 

Petrolati mollis q. s. ad 100. 

To be used with great care in treating very young children. 



16. 

Acidi borici 8 

Hydrargyri ammoniati , 8 

Glyceriti amyli q. s. ad 100. 



Use in eczema impetigo. 



17. 

Hydrargyri oxidi flavi 3 

Petrolati mollis q. s. ad 100. 

Use in eczema impetigo. 

(Gaucher.) 



FORMULARY. 11B 

ECZEMA ANI. 

1. 

Chloralis 3 

Glycerini 50 

Aquae q. s. ad 100. 

{Gaucher.) 



2. 

Acidi tannici 4 

Adipis q. s. ad 100. 



3. 

Extracti kramerise 12 

Petrolati mollis q. s. ad 100. 



4. 

Mentholis 1 

Petrolati mollis q. s. ad 100. 

To be used if pruritus is severe . 



5. 

Cocainse hydrochloratis 1 

Unguenti 100. 



ECZEMA AURIUM. 



1. 

Sodii carbonatis 2 

Glycerini q. s. ad 100. 

Pour into the external auditory meatus to loosen the scales, 
and remove them with a syringeful of warm water. 



2. 

Zinci sulphatis 1 

Glycerini q. s. ad 200. 

Warm and pour into the external auditory meatus, using 
from ten to fifteen drops daily . 

8 



114 SKIN DISEASES OF CHILDREN. 

3. 

Argenti nitratis 1 

Aquae destillatae q. s. ad 100. 

Paint the surfaces with a brush. Cease the application if 
any pain arises. 

(Gniber.) 

4. 

Unguenti diachyli 50 

Petrolati mollis q. s. ad 100. 

Apply on cloths. 

5. 

Glycerini 10 

Olei fagi 20 

Unguenti aquae rosae q. s. ad 100. 

Apply in chronic cases when the epidermis is thickened. 

(Politzer.) 

6. 

Creolini 1 

Aristolis 4 

Unguenti hydrargyri nitratis 35 

Unguenti zinci oxidi q. s. ad 100. 

(Shoemaker.) 



ECZEMA CAPITIS. 



1. 

Naphtolis 1 

Olei olivae q. s. ad 100. 

Use to soften the crusts. 

(Kaposi.) 

2. 

Acidi salicylici 1 

Olei niorrhuae q. s. ad 100. 

Apply locally to soften the crusts. Wash off the softened 

masses every day or every other day with the liniment of 

soft soap. 

(Baginsky.) 



FORMULARY. 115 

3. 

Acidi carbolici 1 

Balsami Peruviani 2 

Oleiolivae q. s. ad 100. 

Use to soften the crusts. If the inflammation is severe cold 
douches or compresses may be used . 

Kaposi.) 

4. 

Zinci oxidi 5 

Petrolati mollis 50 

Adipis lanae hydrosi q. s. ad 100. 

Allow to remain on the scalp for one or two days, then apply 
Lassar's paste. When desired, remove the paste and crusts 
with a two per cent boric acid ointment in vaseline . 

(Baginsky.) 



5. 

Acidi salicylici 2 

Zinci oxidi 25 

Amyli 25 

Petrolati mollis q. s. ad 100. 

Apply in a thick layer. 

(Lassar.) 



6. 

Zinci oxidi 25 

Amyli 25 

Petrolati mollis q. s. ad 100. 

Apply in a thick layer. An inert powder may be applied 

over the paste. 

(Lassar.) 



7. 

Sulphuris prsecipitati 4 

Zinci oxidi 25 

Amyli 25 

Adipis lanae hydrosi 25 

Petrolati mollis q. s. ad 100. 

Apply in a thick layer. 

(Ihle.) 



116 SKIN DISEASES OF CHILDREN. 

ECZEMA LABIORUM. 

1. 

Hydrargyri chloridi corrosivi 1 

Tincturae benzoini q. s. ad 500. 

{Taylor.) 

2. 

Acidi salicylici 2 

Petrolati mollis q. s. ad 100. 

(Kaposi.) 



Hydrargyri oxidi flavi 3 

Petrolati mollis q. s. ad 100. 

(Gaucher.) 

4. 

Thymolis 1 

Unguenti aqua? rosae q. s. ad 100. 



ECZEMA NARIUM. 

1. 

Acidi salicylici 1 

Olei amygdalae expressi q. s. ad 1000. 

Introduce into nasal cavities on tampons of cotton. 

(Besnier.) 

2. 

Glyceriti plumbi subacetatis 50 

Unguenti aquas rosae q. s. ad 100. 

(Hardaway.) 

3. 

Zinci oxidi 10 

Olei theobromatis q. s. ad 100. 

Insert in nasal cavity. Each suppository should contain one 

grain of the oxide. 

(Neumann.) 



FORMULARY. 
ECZEMA PALPEBRARUM. 

1. 

Acidi borici 5 

Glycerini 5 

Unguenti q. s. ad 100. 

2. 

Hydrargyri oxidi flavi 1 

Unguenti aquae rosse q. s. ad 100. 

(Kaposi.) 

3. 

Aristolis 2 

Unguenti aquae rosae q. s. ad 100. 

4. 

Europheni 3 

Unguenti q. s. ad 100. 

(Shoemaker. ) 



117 



ECZEMA UMBILICI. 

1. 

Thymolis 1 

Cinchonas rubrae pulveris 50 

Bismuthi subnitratis q. s. ad 100. 

(Shoemaker.) 

2. 

Liquoris plumbi subacetatis 50 

Aquae q. s. ad 100. 

Apply on tampons moistened with the solution. 

3. 

Cocainae hydrochloratis 1 

Extracti belladonnas foliorum alcoholici 4 

Acidi tannici 6 

Unguenti zinci oxidi q. s. ad 100. 



118 SKIN DISEASES OF CHILDREN. 

ERYSIPELAS. 

1. 

Quininge sulphatis 1 

Acidi sulphurici, q. s. ad sol. 

Syrupi 50 

Aquae destillatae , .q. s. ad 100. 

A teaspoonful every two hours for a nursing child. If pre- 
ferred, the tincture of iron may be given in doses of from five 
to ten drops every two hours, and to nursing children two drops 
every two hours. 

2. 
Pilocarpine hydrochloratis q s. 

Use subcutaneously in doses of from one-tenth of a grain to 
three-tenths of a grain each. Repeat after two, eight, and ten 
hours. It may also be given internally at the same time. 

(Bau.) 



Sodii benzoatis q. s. 

Give from five to ten grains, in divided doses, during twenty- 
four hours. 

(Schiller. ) 

4. 
ANTISTREPTOCOCCIC SERUM TREATMENT. 

Give in hypodermatic doses of ten cubic centimetres each. 
These doses are of a serum prepared by Marmorek which is 
constant in strength and character. 



Ichthyolis 50 

Adipis lanse hydrosi q. s ad 100. 

Employ multiple scarification of the affected area, reaching 
into the corium and partly into the subcutaneous tissue. The 
surface is thoroughly washed with an antiseptic solution, and 
as much of the cedematous fluid as possible is expressed. An 
incision reaching to the corium is made, completely encircling 
the affected area. The ointment is now rubbed in and applied 
plentifully over the surface, which is covered with gauze and 



FORMULARY. 119 

a thick layer of cotton. The treatment is continued for a few 
days after the temperature has subsided. In most cases an- 
esthesia is necessary. 

(Felsenthal.) 



Alcoholis absoluti q. s, 

Apply continuously on thoroughly wet compresses or cotton 
covered with some impermeable material. Change every fifteen 
or twenty minutes, and apply lanoline when scaling occurs. 

{Sarysdorff. ) 

7. 

Ichthyolis 25 

Liquoris gutta-perchae q. s. ad 100. 

Apply with a brush. Application should extend beyond the 
affected area by three-quarters of an inch. If the face is 
affected, surround the ears, even if not affected, with a band 
of the application. 

8. 

Extracti ergota? 1 

Extracti ergotae fluidi 10 

Adipis lanse hydrosi 20 

Adipis q. s. ad 100. 

Apply locally in cases of facial erysipelas. 

(Lees.) 



ERYTHEMA. 



1. 

Zinci oxidi 10 

Talci 50 

Magnesise q. s. ad 100. 

(Baginsky.) 

2. 

Acidi salicylici 1 

Magnesiae 50 

Amyli q. s. ad 100. 



120 SKIN DISEASES OF CHILDREN. 

3. 

Acidi borici .- . 1 

Magnesiae 50 

Amyli q. s. ad 100. 

4. 

Zinci oxidi 3 

Calaminae praeparatae 3 

Liquoris calcis q. s. ad 100. 

(Rotch.) 

5. 

Acidi borici 4 

Glycerini 30 

Aquae rosae fortioris q. s. ad 100. 

(Shoemaker.) 



ERYTHEMA NODOSUM. 

1. 

Sodii salicylates 10 

Amyli q. s. ad 100. 

Apply on wet cloths. Quinine or salicylate of soda may be 

given internally. 

(Monti.) 

2. 

Argenti nitratis 6 

Aquae q. s. ad 100. 

(Jacobi.) 

3. 

Olei gaultheriae q. s. 

Use as an inunction. 

4. 

Potassii iodidi 25 

Glycerini sive 

Adipis lanae hydrosi q. s. ad 100. 

Apply locally. If preferred, lead water (pure or combined 
with opium) may be applied. 



FORMULARY. 121 

FAYUS. 

1. 

Acidi carbolici 3 

Aquas q. s. ad 100. 

The head is washed and shaved, and epilation is performed. 
Compresses wet with this solution are then applied continuously 
from morning until evening, but are removed at night. A coil 
is laid on the compresses, through which water passes at a tem- 
perature of from 125° to 130° F. The compresses consist of 
about sixteen thicknesses of gauze. If any signs of carbolic 
poisoning arise, change the solution to a one-quarter per cent 
sublimate solution, or the latter may be used from the first. 
Treatment is continued during from eight to fourteen days, 
when boric vaseline is applied. The child can move about in 
bed, but the coil must cover the entire scalp, and there should 
be as little space as possible between the tubes of the coil. 

(Zinsser. ) 



2. 

Acidi borici 3 

Alcoholis 50 

^theris q. s. ad 100. 

(Shoemaker.) 

3. 

Thymolis 2 

Chloroformi 20 

Olei olivaG q. s. ad 100. 

Apply on compresses three times daily. When microscopic 
examination of the scales shows that there are no more fungi 
present, paint the surface daily during eight days with a thirty 
per cent solution of glycerine and the tincture of iodine. 

(Gouladze.) 



4. 

Losophani 10 

Unguenti aquse rosoc 20 

Adipis lanse hydrosi q. s. ad 100. 

Apply twice daily. 

(Saalfeld. ) 



122 SKIN DISEASES OF CHILDREN. 

5. 

Potassii carbonatis 2 

Sulphuris subliuiati 8 

Tincturse iodidi 25 

Olei picis liquidae 25 

Adipis q. s. ad 100. 

Apply once daily. Continue until active desquamation is 
established, and allay inflammation with a paste of zinc oxide, 
starch, and salicylic acid. 

(Tsitrine.) 



FRECKLES AND OTHER PIGMENTATIONS. 

1. 

Hydrargyri chloridi corrosivi 1 

Aquae q. s. ad 100. 

Apply on closely fitting cloths. The patient is to remain in the 
horizontal position and the cloths are to be kept moist for four 
hours. Pierce the bullae at their lower edges, so as to cause 
them to collapse, and apply an inert powder. The crust will 
fall off within a week, and the newly-formed epidermis will be 
unpigmented. This method is very painful and should not be 
used with children under ten years of age in cases of freckles 

on the face. 

(Kaposi. ) 



Glycerini 2 

Naphtolis 4 

Linimenti saponis mollis q. s. ad 100. 

Apply once daily as a wash. 



3. 

Hydrargyri chloridi corrosivi 1 

Tincturse benzoini 90 

Aquae aurantii florum f ortioris 900 

Ernulsi amygdalae 3000. 

Apply once daily as a wash. 



FORMULARY. 123 



Saponis mollis q. s. 

Wash the face daily with the soft soap and water, and then 
paint it with either a weak salt or acetic acid solution. 



5. 

Hydrargyri ammoniati . 15 

Bismuthi subnitratis 15 

Glyceriti aniyli q. s. ad 1 00. 

Apply every other day. 

(Hager.) 



6. 

Acidi salicylici , 2 

Tincturse benzoini 4 

Unguenti aquas rosae q. s. ad 100. 

Spread on gauze and leave on over night in cases of freckles. 



7. 

Bismuthi subcarbonatis 10 

Talci 25 

Sulphuris praecipitati 30 

Olei rosae q. s. 

Barii dioxidi q. s. ad 100. 

To be used if the skin becomes red and scaly in the course of 

healing. 

(Kaposi.) 



FURUNCLE. 



1. 
Extract! colchici radicis q s. 

Give in doses of from one-third to one-half of a grain two or 
three times daily. Locally, the area affected is well washed 
with spirits of camphor, and VidaFs red plaster is then applied. 

(Brocq. ) 



124 SKIN DISEASES OF CHILDREN. 



GALVANO-CAUTERIZATION TREATMENT. 

Use a thin platinum wire point about one-quarter of an inch 
in length and one- twenty fifth of an inch in diameter, at white 
heat. It is passed into the follicle to the root of the hair.' If 
applied early enough it is abortive in its action. If used later, 
when a little pus is already present, the application must be 
prolonged until the pus is entirely dried up by the heated wire. 
A thermo-cautery may be used, but it is more painful and causes 
greater destruction of tissue. 

(Loewenburg.) 



3. 

Camphoros 55 

Acidi carbolici q. s. ad 100. 

Wash well with alcohol and apply a tampon moistened with 
this solution. Renew every twenty-four hours until active in- 
flammation has subsided, then substitute a four-fifths per cent 
ointment of the yellow oxide of mercury. If an incision is 
necessary, incise to periosteum and reapply tampon. Care 
should be taken in cases of small children, on account of the 
amount of carbolic acid employed. To be used for small 
furuncles in the ear only. 

(McCuen Smith.) 



4. 

Acidi salicylici 10 

Emplastri saponis q. s. ad 100. 

Apply to the affected parts. A two per cent solution of car- 
bolic acid may be used first. 

(Newberger. ) 



HYPERIDROSIS. 



1. 
Agaracini q. 

Give one-thirtieth of a grain every three hours. 



FORMULARY. 125 

2. 
Pulveris agarici albi q. s. 

Give from one to two grains three times daily. 

3. 
Atropinae sulphatis q. s. 

Give in doses of from one-three-hundredth of a grain to one- 
one-hundred-and fiftieth of a grain twice daily. 



4. 

Zinci oxidi , 10 

Amyli q. s. ad 100. 

Apply on lint in the interspaces between the fingers, toes, 
genital folds, and axillse. This powder may also be placed in 
the stockings. 

5. 

Naphtolis 1 

Acidi salicylici 2 

Amyli q. s. ad 100. 

Apply as in No. 4. 

(Kaposi.) 



Acidi tannici 1 

Alcoholis q. s. ad 200. 

Use as a local wash in cases of hyperidrosis of axillee, geni- 
tals, palms of the hands, or soles of the feet. 



7. 

Hydrargyri chloridi corrosi vi 1 

Aquae q. s. ad 800 

Use as a local wash. 



8. 

Naphtolis 1 

Spiritus odorati 3 

Alcoholis q. s. ad 300. 



Apply locally as a wash. 



126 SKIN DISEASES OF CHILDREN. 

9. 

Balsami Peruvian! 1 

Acidi f ormici 5 

Chloralis 5 

Alcoholis q. s. ad 100. 

Apply with cotton that can be destroyed subsequently. In 
cases of slight severity the chloral may be omitted. If a more 
powerful action is desired, add one per cent of trichloracetic 
acid. This solution may also be used in the form of a spray 
in cases of general hyperidrosis. 

(Huesner. ) 



10. 

Unguenti picis liquidae 50 

Ungaenti sulphuris q. s. ad 100. 

Wash the parts with juniper or tar soap. Apply on cloths. 
(Van Harlingen.) 



11. 

Emplastri plumbi 20 

Olei oli vae q. s. ad 100. 

Sub leni igni et addendo pauxill. aqu. font, coque ut f. 

ungu. consistent spissior. 
Adder Olei lavandulse florum 2 

Apply once daily on cloths. Dry the feet with powder or 
lint, but do not wash them. Repeat for from ten to fourteen 
days. Bathe when exfoliation occurs. Use in severe cases 
only. 

(Hebra.) 



ICHTHYOSIS. 



1. 

Acidi salicylici 2 

Adipis lanse hydrosi 50 

Petrolati mollis q. s. ad 100. 



FORMULARY. 127 

2. 

Acidi carbolici 1 

Adipis q. s. ad 100. 



Resorcini 4 

Petrolati mollis 50 

Adipis lanse hydrosi q. s. ad 100. 

(Gaucher.) 



Tincturse iodidi 25 

Glycerini 40 

Olei theobromatis q. s. ad 100. 

(Perez.) 



Acidi tartaric! 3 

Glyceriti amyli q. s. ad 100. 

Apply at first every evening, later every two or three days, 
then once a week, and finally from time to time. When this 
is not applied, use the glycerite of starch every evening. 

(Vidal.) 



Naphtolis 2 

Petrolati mollis .q. s. ad 100. 

Rub in sparingly once or twice daily. Naphthol soap may 
also be used every other day. In young children inunctions of 
pure soft soap may be used exclusively. 

(Kaposi.) 



128 SKIN DISEASES OF CHILDREN. 

IMPETIGO. 



Hydrargyri chloridi corrosi vi 1 

Aquae q. s. ad 100. 

Remove the crusts. Stop all hemorrhage with tampons- 
Rub the affected areas, especially the borders of the pustules, 
with this solution. Repeat until no new pustules occur. In 
most cases two to three daily successive applications are suffi- 
cient. If no new pustules appear, those already treated heal 
rapidly under a zinc ointment or a plaster. 

(Neebe.) 



2. 

Olei cadini 50 

Olei oli vne . q. s. ad 100. 



3. 

Hydrargyri oxidi flavi 5 

Petrolati mollis q. s. ad 100. 



4. 

Salolis 10 

Petrolati mollis q. s. ad 100. 



5. 

Acidi borici 8 

Zinci oxidi 12 

Glyceriti amyli q. s. ad 100. 



6. 

Acidi borici .' 8 

Hydrargyri ammoniati 8 

Petrolati mollis q. s. ad 100. 



7. 

Acidi salicylic! 1 

Ziaci oxidi 10 

Petrolati mollis q. s. ad 100. 

{Gaucher.) 



FORMULARY. 129 

INTERTRIGO. 

1. 

Acidi chromici 3 

Aquae q. s. ad 100. 

Wash and dry the parts carefully. Paint with this solu- 
tion, and cover it with some bland powder. Repeat every 
three or four days. Not more than two or three applications 
are required generally. If there is great irritation of the parts, 
some weak antiseptic solution should be used first. This treat- 
ment prevents recurrence, by tanning the skin. 

(Brault.) 



Argenti nitratis 2 

Aquae q. s. ad 100. 

To be used in very obstinate cases limited to the anus or 
genitals. A three-quarters per cent solution of bichloride of 
mercury may be used if preferred. Bichloride or bran baths at 
a temperature of 80° F. are often effective. 

(Henoch. ) 



Ichthyolis 1 

Aquae q. s. ad 200, 

Apply locally if the parts are infected. Powder is to be 
applied over this. The parts should be kept separated with 
cotton covered with starch . 



4. 

Resorcini i 

Aquae q. s ad 100. 



Apply locally as in No. 3. 



5. 

Olei olivae 50 

Liquoris calcis q. s. ad 100. 

9 



130 SKIN DISEASES OF CHILDREN. 

6. 

Bismuthi subnitratis 1 

A.dipis lanae hydrosi q. s. ad 100. 



7. 

Acidi salicyiici 1 

Cetacei 10 

Adipis lanae hydrosi q. s. ad 100. 

(Widerhofer.) 



Ichthyolis 2 

Olei olivae 20 

Adipis lanse hydrosi q. s. ad 100. 

(Monti.) 



9. 

Zinci oxidi 10 

Petrolati mollis q. s. ad 100. 

(Neumann.) 



LUPUS. 

1. 

Argenti nitratis 30 

Aquae destillatae q. s. ad 100. 

Paint the affected areas. 



2. 

Acidi lactici 80 

Aquae .q. s. ad 100. 



3. 

Acidi tartarici 2 

Alcoholis 15 

Acidi carbolici 25 

Olei ricini ... 25 

Carnphorae q. s. ad 100. 

(Gaucher.) 



FORMULARY. 131 

4. 

Iodi 25 

Potassii iodidi 25 

Glycerini q. s. ad 100. 

Paint the surface affected. 



5. 

Acidi arsenosi 3 

Hydrargyri sulphidi rubri 12 

Unguenti hydrargyri oxidi rubri q. s. ad 100. 

Spread on linen and cut into sizes desired 

(Hebra.) 



Hydrargyri chloridi corrosivi I 

^Etheris, q s. ad sol. 

Petrolati mollis q. s. ad 100. 

To be applied over small surfaces only. 
(Doutretepont .) 



7. 

Hydrargyri iodidi rubri 50 

Adipis q. s. ad 100. 

Apply locally. Warm before using. 

(Hardy.) 



Acidi pyrogallici 10 

Petrolati mollis .q. s. ad 100. 

(Schivimmer. ) 



9. 

Resorcini 35 

Petrolati mollis q. s. ad 100. 

(Bertarelli.) 



132 SKIN DISEASES OF CHILDREN. 

10. 

Creosoti 4 

Acidi salicylici 20 

Ernplastri plumbi q. s ad 100. 

(Besnier.) 



11. 

Potassii chloridi 25 

Potassii nitratis 25 

Zinci chloridi q. s. ad 100. 

Melt together in the form of a pencil. Apply locally. 

(Koebner.) 



12. 

Zinci chloridi 50 

Aquae q. s. 

Amyli , q s. ad 100. 

Make into a solid mass. At the time of application, cut off 

the i-mount desired. 

(Canquoin.) 



LUPUS ERYTHEMATOSUS. 

1. 

Iodi 10 

Potassii iodidi 20 

Aquae q. s. ad 100. 

Apply with a brush once or twice daily until sufficient irri- 
tation is induced. 

(Hardy.) 



2. 

Ichthyolis 15 

Petrolati mollis q. s. ad 100. 

Apply over night. Wash with warm water in the morning 
and apply some bland or antiseptic ointment, as oxide of zinc 
or a ten per cent boric acid ointment in vaseline. If irritation 
is then extreme, continue with the non-irritating ointment. 
Otherwise use the ichthyol for some nights. 



FORMULARY, 133 



Acidi salicylici 3 

Petrolati mollis q. s. ad 100. 



Apply as in No. 2. 



Resorcini 10 

Petrolati mollis q s. ad 100. 

Apply as in No. 2. 

{Gaucher.) 



MILIARIA. 
1. 



Camphorae 6 

Bismuthi subnitratis 15 

Zinci oxidi q. s. ad 100. 



2. 

Calamine praeparatae 3 

Zinci oxidi 6 

Glycerini 12 

Liquoris calcis 24 

Aquae rosae fortioris q. s. ad 100. 

Apply on a piece of muslin dipped in the solution. Bandage 
it on if necessary. Calomel or saline laxatives may also be 
given, or diuretics in the form of the nitrate of potash or the 
sweet spirits of nitre. 

(Holt.) 



3. 

Liquoris plumbi subacetatis 1 

Tincturae opii 4 

Aquae q. s. ad 100. 

Apply locally and follow with the application of a boric acid 
powder. To be used in cases of lichen strophulous. 

(Crocker. ) 



134 SKIN DISEASES OF CHILDREN. 

N^YUS VASCULOSUS. 

VACCINE-LYMPH TREATMENT. 

Three to six superficial cross-incisions are made in the tumor, 
and the vaccine is introduced in the same manner as in the 
ordinary process of vaccination. This treatment is to be used 
in the case of a child who has never been vaccinated. It is 
likely to leave a larger scar than the electrolytic needle, but is 
often effective in cases of nsevi of moderate size. The child is 
usually vaccinated in some other part of his body at the same 
time. 



Hydrargyri chloridi corrosivi 10 

Collodii q. s. ad 100 

Apply with a brush to the area affected. This is recommended 
highly by various writers for the treatment of ngevus flam- 
meus and araneus, as well as nsevus tuberosus, if the latter is 
small. 



DISEASES OF THE NAILS. 

ECZEMA OF THE NAILS. 

1. 

Acid salicylici 5 

Petrolati mollis q. s. ad 100. 



Ichthyolis 10 

Petrolati mollis q. s. ad 100. 



Unguenti cum styrace 30 

Olei olivse q. s. ad 100. 



FORMULARY. 135 



4. 



Naphtolis 4 

Petrolati mollis q. s. ad 100. 

{Gaucher.) 



o. 

Oleati stanni 6 

Petrolati mollis q. s. ad 100. 

(Shoemaker.) 



FAVUS OF THE NAILS. 

1. 

Hydrargyri chloridi corrosi vi 3 

Aquae q. s. ad 300. 

Remove or scrape and file away the nail until perforated. 
Curette the small yellow areas. Apply the solution on small 
cotton tampons. Keep in position with a bandage. 



2. 

Naphtolis 5 

Petrolati mollis q. s. ad 100. 



3. 

Acidi pyrogallici 5 

Adipis lanaa hydrosi q. s. ad 100. 



4. 

Acidi chrysophanici 8 

Adipis lanae hydrosi q s ad 100. 

(Gaucher.) 



PSORIASIS OF THE NAILS. 

1. 

Gallanolis 10 

Alcoholis q. s. ad 100. 



136 SKIN DISEASES OF CHILDREN. 



o 



Acidi chrysophanici , 10 

Chloroformi q. s. ad 100. 



o. 

Acidi pyrogallici 10 

^theris q. s ad 100. 

4. 

Gallanolis 15 

Petrolati mollis q. s. ad 100. 



Gutta-Perchee 10 

Chloroformi q. s. ad 100. 



Apply with a soft brush. 



Gutta-Perchee 10 

Gallanolis 10 

Chloroformi q. s. ad 100. 

Paint the affected area. 

{Gaucher.) 



RINGWORM OF THE NAILS. 

1. 

Hydrargyri chloridi corrosivi 1 

Alcoholis q. s. ad 200. 

Scrape away as much of the nail as possible and apply as 
a wet compress once daily. In the intervals between the appli- 
cations of this solution, apply a boric acid ointment. 

{Gaucher.) 

2. 

Iodi 1 

Potassii iodidi 2 

Aquae destillatse q. s. ad 1000. 

Apply constantly as a wet dressing, and keep in place with 
rubber finder stalls. 



o 



{Sabouraud. ) 



FORMULARY. 137 

3. 

Acidi pyrogallici 50 

Olei olivae q. s. ad 100. 

Bandage in position . The nail will become movable in a few 
days, when apply an antiseptic dressing twice daily. 

(Pellizari. ) 



PHTHIRIASIS. 
PHTHIRIASIS CAPITIS. 



1. 
Linimenti saponis mollis q. s. 

The hair is to be cut, if possible, and thoroughly washed with 
the liniment. When the hair cannot be cut, the head is to be 
thoroughly washed and a one- third per cent sublimate solution 
in vinegar is then to be applied. Spirits of camphor or warm 
vinegar may be used in the same way. After twenty- four hours 
the head is to be washed again with soft soap and thoroughly 
combed with a fine comb wet in vinegar. 

{Gaucher.) 



Acidi carbolici 2 

Olei olivae q. s. ad 100. 

Rub in well and cover the head with a cloth. 



{Monti.) 



3. 

Balsami Peruviani 3 

Olei olivae 35 

Petrolei q. s. ad 100. 

Rub the scalp thoroughly with this solution. Cover it with 
flannel over night and wash with soft soap in the morning. 
Repeat for two or three days. Nits are to be removed by 
washing the hair with vinegar and combing it with a fine 
comb. 



138 SKIN DISEASES OF CHILDREN. 

4. 

Naphtolis 1 

Olei olivae q. s. ad 100. 

(Kaposi.) 
PHTHIRIASIS CORPORIS. 



Acidi carbolici 1 

Aquas q. s. ad 100. 

The patient is to be well bathed; his clothes are to be exposed 
to a high temperature; and a complete change of clothing is to 
be made. This alone is often effective. In a chronic case with 
severe cutaneous lesions, fumigation, sulphur baths, a mild 
solution of sublimate, or the above-mentioned solution may be 
used. Jamieson recommends wearing a piece of roll sulphur, 
about the size of a pigeon's egg, next to the skin. It is to be 
wrapped up in gauze and worn day and night. 



PHTHIRIASIS PUBIS. 

1. 

Hydrargyri chloridi corrosivi 1 

Alcoholis q. s. ad 500. 

Apply locally and wash the parts with warm water. One 
application is generally sufficient, but it may be necessary to 
repeat it two or three times. 



Hydrargyri chloridi corrosivi 1 

Aquas destillatae q. s. ad 100. 



Apply as in No. 1. 



Hydrargyri ammoniati 10 

Unguenti aquas rosas q. s. ad 100. 

(Kaposi.) 



FORMULARY. 139 

PRURIGO. 

1. 

Acidi carbolici 1 

Aquae destillatae q. s. ad 100. 

Inject one small hypodermatic syringef ul every day or every 
other day. Use lanoline externally and warm baths at the 
same time. 

(Monti.) 



2. 

Calcis o 8 

Sulphuris sublimati 16 

Coq. c. aq. fervid 160 

Ad reman 100. 

Cola et filtra. 

To be well rubbed into the skin. 

(Henoch.) 



3. 

Petrolei 50 

Glycerini q. s. ad 100. 

For nursing children. Rub in with flannel wet with the solu- 
tion. In private practice substitute the balsam of Peru for 
the petroleum and apply with a brush. 

(Monti.) 



Naphtolis 1 

Petrolati mollis q. s. ad 100. 

Apply two or three times daily. Rub dry with cotton after 
the last daily application. Bathe the patient after ten or twelve 
applications. 

(Baginsky.) 



5. 

Unguenti diachylon . 50 

Petrolei q. s. ad 100. 

Apply on flannel three times daily if itching is severe. 



140 SKIN DISEASES OF CHILDREN. 

PRURITUS CUTANEUS. 

1. 

Camphorae 2 

Zinci oxidi 50 

Amyli q. s. ad 100. 



2. 

Hydrargyri chloridi corrosivi 1 

Alcoholis 50 

Aquae laurocerasi 50 

Aquae q. s. ad 1000. 



3. 

Chloralis 2 

Glycerini 15 

Alcoholis 15 

Aquae q. s. ad 100. 



4.- 

Mentholis 1 

Glycerini 20 

Alcoholis q. s. ad 200. 



(Kaposi.) 



5. 



Acidi carbolici 1 

Zinci oxidi 15 

Petrolati mollis q. s. ad 100. 



Camphorse 10 

Petrolati mollis q. s. ad 100. 



7. 

Cocainse hydrochloratis 1 

Petrolati mollis q. s. ad 100. 



(Gaucher.) 



FORMULARY. 141 

PSORIASIS. 

1. 

Olei cadini 10 

Glyceriti amyli q. s. ad 100. 



2. 

Acidi chrysophanici. 5 

Petrolati mollis q. s. ad 100. 



3. 

Acidi salicylici 3 

Olei cadini 5 

Petrolati mollis q. s. ad 100. 



4. 

Sulphuris sublimati 12 

Olei cadini 12 

Petrolati mollis q. s. ad 100. 



5. 

Hydrargyri ammoniati 10 

Petrolati mollis q. s. ad 100. 



6. 

Hydrargyri oxidi rubri 6 

Petrolati mollis q s. ad 100. 

(Gaucher.) 



7. 

Acidi salicylici 2 

Sulphuris praecipitati 10 

Zinci oxidi 20 

Amyli 20 

Petrolati mollis q. s. ad 100. 

To be used before the application of chrysarobin, combined 
with protracted baths. 

(Lassar.) 



14:2 SKIN DISEASES OF CHILDREN. 



Gallacetophenoni 10 

Unguenti q. s. ad 100. 

Apply as an ointment. ISTon-irritating. Effective, but slow 
in its action. 

(Gall.) 



Chrysarobini 20 

Zinci oxidi 20 

Adipis lange hydrosi 30 

Petrolati mollis q. s. ad 100. 

To be used on small areas only. 

(Neisser.) 



10. 

Chrysarobini 8 

Liquoris gutta-perchse 8 

Chloroformi q. s. ad 100. 

To be applied to affected parts twice a week. 

(Ashby & Wright.) 



PURPURA RHEUMATICA. 

1. 
Extracti ergotae 



Give one-tenth of a grain in pill form three times a day. It 
may be given subcutaneously in doses of one and one-half 
grains every other day, but is very liable to cause abscesses. 



2. 

Extracti opii 4 

Unguenti aquae rosse q. s. ad 100. 

Not to be applied over a large area in cases of young children. 



FORMULARY. 143 

3. 

Extracti opii 6 

Emplastri saponis q. s. ad 100. 

Apply on linen and bandage in place. Not to be used in 
cases of very young children. 



RINGWORM. 



1. 

Formalini 15 

Alcoholis q. s. ad 100. 

Shave the hair around the margin of the patches and rub in 
the fluid vigorously with a brush for ten minutes every other 
day. Apply four times. Salter recommends a forty per cent 
solution . 

2. 

Acidi borici 3 

Tincturse camphorse 3 

Glycerini 6 

Aquas aurantii florum f ortioris q. s. ad 100. 

To be used as a hair wash. 

(Franke.) 

3. 

Hydrargyri iodidi rubri 1 

Hydrargyri chloridi corrosivi 4 

Alcoholis 50 

Aquas destillatae q. s. ad 200. 

Use once daily in cases of children who cannot bear chrysa- 

robin. 

(Quinquand.) 

4. 

Naphtolis 1 

Balsami Peruviani 3 

Sulphuris praecipitati 15 

Spiritus lavandulse 25 

Olei cadini 25 

Linimenti saponis mollis q. s. ad 100. 



Apply once daily with a brush. 



144 SKIN DISEASES OF CHILDREN. 

5. 

Tincturae cantharidis 6 

Tincturae capsici 6 

Olei ricini 6 

Tincturae nucis vomicae 12 

Spiritus odorati q s. ad 100. 

(Jamieson.) 



Cupri sulphatis 3 

Hydrargyri ammoniati 3 

Sulphuris sublimati 4 

Olei cadini 25 

Petrolati mollis q. s. ad 100. 

To be used once daily in cases of children who cannot bear 
chrvsarobin. 



Acidi carbolici 2 

Olei cadini 20 

Sulphuris sublimati 20 

Tincturae iodidi 20 

Petrolati mollis q. s. ad 100. 

Use as in No. 0. 

(Smith.) 



Acidi borici 1 

Acidi salicylici • • 5 

Chrysarobini 15 

Petrolati mollis q. s. ad 100. 

Apply once daily. Use only in severe cases occurring with 

older children. 

(Quinquand. ) 



SCABIES. 



1. 

Styracis ■ 25 

Balsami Peruviani 25 

Olei ricini q. s ad 100. 

Rub into the affected parts. 

(Baginsky.) 



FORMULARY. 145 

2 

Creolini 5 

Olei olivae q. s. ad 100. 

Apply copiously over night. 

(Jacobi.) 



3. 

Balsami Peruviani 50 

Glycerini q. s. ad 100. 

Bathe the body with soft soap and warm water. Paint on 
the fluid and leave it on over night. Apply again next morn- 
ing, omitting the bathing. 

{Monti.) 



4. 

Naphtolis 1 

Cretse proeparatse 12 

Saponis mollis 60 

Adipis q. s. ad 200. 

Apply to the affected parts without a preceding bath. Wool- 
len underclothing is to be worn, or the patient should lie between 
woollen blankets. Powder the skin thoroughly, and do not 

bathe for one week. 

(Kaposi.) 



5. 

Olei lavandulae florum 1 

Olei caryophylli 1 

Potassii carbonatis 25 

Sulphuris prsecipitati q. s. ad 100. 

Adipis q. s. ut f. unguent. 

(Hebra.) 



0. 

Sulphuris prsecipitati 10 

Balsami Peruviani 10 

Petrolati mollis q. s. ad 100 

Bathe with soap and hot water, and apply the ointment. 
Repeat for two or three successive nights. The bedding and 
patient's clothing are to be sterilized by dry or moist heat. 

(Holt.) 
10 



146 SKIN DISEASES OP CHILDREN. 

7. 

Balsami Peruviani 50 

Unguenti aquae rosae q. s. ad 100. 

Wash the skin well and rub in at night. Bathe on the fol- 
lowing morning. Repeat daily for three or four days. 

(Widerhofer.) 



8. 

Cretae praeparatae 8 

Olei cadini 15 

Sulphuris sublimati 15 

Saponis mollis 30 

Petrolati mollis q. s. ad 100. 

To be used in cases in which styrax or naphthol is contra- 
indicated. 

(Williamson.) 



SEBORRHCEA. 

SEBORRHOEA CAPITIS 

1. 

Athens 4 

Sodii boratis 5 

Aquae . q. s. ad 100. 

Shake before using. 

(Hillairet.) 



2. 

Glycerini 2 

Tincturae benzoini 2 

Acidi borici 4 

Alcoholis q. s. ad 100. 

Apply daily or every other day with a brush. 

{Kaposi. ) 



3. 

Sodii bicarbonatis 10 

Aquae q. s..ad 100. 

Apply after removal of the scales. 



FORMULARY. 147 

4. 

Balsami Peruvian! 2 

Olei olivae q. s. ad 100. 

Remove the crusts and apply locally. 



Acidi carbolici 1 

Olei olivae q. s. ad 200. 

Apply as in No. 4. 

(Gaucher.) 



6. 

Resorcini 2 

Unguenti aquae rosse q. s. ad 100. 

Keep the scalp covered with the ointment. 



7. 

Sulphuris prgecipitati. . . 12 

Adipis lanas hydrosi q. s. ad 100. 

Apply as in No. 6. 

(Holt.) 



Unguenti hydrargyri oxidi flavi 5 

Petrolati mollis q. s. ad 100. 

(Ashby & Wright.) 



SEBORRHCEA SQUAMOSA NEONATORUM. 

The body should be vigorously rubbed with oil and methodi- 
cally wrapped in cloths smeared with a bland ointment. 
Warm baths are to be given daily and oily substances again 
applied. An incubator should be used, or the child should be 
wrapped in down or woollen coverings. 



148 SKIN DISEASES OF CHILDREN. 

SEBORRHCEA BALANITIS AND POSTHITIS. 

1. 

Am yli 50 

Talci q. s. ad 100. 

Apply to the affected parts on pieces of linen or cotton. 

2. 

Kaolini 50 

Magnesiae carbonatis q. s. ad 100. 

Apply as in No. 1. 

3. 

Plumbi acetatis 1 

Aquae q. s. ad 100. 

Apply as in No. 1. 

(Kaposi.) 



SYPHILIS. 



SYPHILIS HEREDITARIA. 
Internal Medication. 

1. 
Hydrargyri chloridi mitis q, s. 

Give from one-twelfth to one-sixth of a grain, mixed with a 
little sugar of milk, in a small spoonful of water, two or three 
times daily. Stir just before giving. If there is any tendency 
to diarrhoea, one-sixtieth to one-twelfth of a grain of opium may 
be added. Widerhofer combines from one and one-half to 
three grains of the saccharated carbonate of iron with the mer- 
cury. 

Hydrargyri tannatis q. s. 

Give in same doses as the calomel, but omit the sugar of 
milk. Especially useful with children who have a tendency to 
diarrhoea. Opium may also be added in the same amounts as 

in No. 1. 

(Heubner. ) 



FORMULARY. 149 

3. 
Hydrargyri iodidi flavi q. s. 

Give from one- sixth to one-twelfth of a grain two or three 
times daily. Potassium iodide or any other iodide must not be 
given at the same time, as a caustic iodide of mercury may 
thus be formed in the intestines. 

(Fournier.) 



4. 
Hydrargyri cum creta q. s. 

Give from one-sixth to one-third of a grain three times a 

day. 

(Hutchinson.) 

Inunctions. 

1. 
Unguenti hydrargyri cum adipe lanae hydroso sive 

cum unguento aquae rosa; parati q. s. 

Rub in from five to seven grains under light pressure for 
from ten to twenty minutes. This is best done in the evening. 
Cover the part rubbed somewhat more warm than the rest of 
the body, and wash it softly but thoroughly the next morning 
with soap and warm water. Change the place of inunction 
each time to a different part of the extremities and trunk. A 
pause of a few days is made after six inunctions. 

(Heubner.) 

2. 
Unguenti hydrargyri q. s. 

Rub the ointment into the palms of the hands and soles of 
the feet every morning and evening. Use five grains for each 
application. Otherwise apply as in No. 1. 

(Hutchinson.) 

3. 

Hydrargyri oxidi rubri , 20 

Olei olivae q. s. ad 100. 

Rub in from five to fifteen grains daily. Otherwise apply as 

in No. 1. 

(Monti.) 



150 SKIN DISEASES OF CHILDREN. 

4. 

Unguenti hydrargyri . ; 50 

Petrolati mollis q. s. ad 100. 

Rub in twenty grains daily. Jacobi recommends the wear- 
ing of a soft piece of leather over the knee, underneath which 
the ointment is applied. If preferred it may be applied under 
a flannel abdominal band. 

Injections. 

1. 

Hydrargyri chloridi corrosivi 1 

Aquae destillatae q. s. ad 500. 

Inject twice daily seven and one-half minims into the muscu- 
lar tissues of the gluteal region. The syringe is to be directed 
at right angles to the skin, which should be previously antisep- 
tically prepared. Avoid moistening with the sublimate solu- 
tion the point of puncture and the opening into the tissues made 

by the needle. 

(Lewin.) 

2. 

Hydrargyri chloridi corrosivi 1 

Sodii chloridi 4 

Aquae destillatae q. s. ad 100. 

In cases of nursing children inject from one-quarter to one- 
half of a small hypodermatic syringeful. One syringeful may 
be used with larger children. 

{Monti.) 

3. 

Hydrargyri chloridi corrosivi 1 

Aquae destillatse q. s. ad 300. 

Inject once or twice daily in doses containing from one-one- 
hundredth to one-fiftieth of a grain of the sublimate. 

(Jacobi.) 

Baths. 
1. 

Hydrargyri chloridi corrosivi 0.5 (gr. vijss.) 

Ammonii chloridi 1.0 (gr. xv.) 

Aquae , q. s. ad 100.0. (§iij.) 

Add to one bath. As a rule one bath every other day. 

{Widerhofer.) 



FORMULARY. 151 

2. 

Hydrargyri chloridi corrosivi 1.0 (gr. xv.) 

Ammonii chloridi 6.0 ( 3 iss.) 

Aquae q. s. ad 200.0.(5 v J s s.) 

Add to one or two baths of five gallons of water. 

{Monti.) 



Ammonii chloridi 2.0 (gr. xxx.) 

Hydrargyri chloridi corrosivi 2.0. (gr. xxx.) 

Add to bath of from five to seven gallons of water. 

(Comby.) 



4. 
Hydrargyri chloridi corrosivi 1.0. (gr. xv.) 

Add to one bath. 

(Jacobi. ) 



The baths are given every day or every other day in an ordi- 
nary baby's bath tub, containing from five to seven gallons of 
water at a temperature of 97° F. To each bath is added from 
one-half a gramme to two grammes (seven and one-half to 
thirty grains) of corrosive sublimate, either pure or with the ad- 
dition of some ammonium chloride. The bath should last from 
ten to fifteen minutes. It is especially indicated in cases of 
general eruption, although Baginsky uses this method in pre- 
ference to all others for all cases. Great care is to be exercised 
during the bath to prevent the child from swallowing any of 
the contents of the tub. 



Plasters. 

1. 
Emplastri hydrargyri q. s. 

The plaster should contain from ten to fifteen per cent of 
mercury. Apply a piece four inches long by two and one-half 
inches wide on the breast or back. Change weekly. This is 
the favorite method used by Fronz in Widerhofer's clinic in 
Vienna, with very good results. 



152 SKIN DISEASES OF CHILDREN. 

2. 

Olei ricini 7 

Hydrargyri chloridi rnitis vap. parat 23 

Emplastri plumbi q. s. ad 100. 

Apply a piece five inches long by two and one-half inches 
wide. Renew weekly. 

(Quinquand.) 

Indirect and other Methods of Treatment. 

It is doubtful whether the mammary glands excrete the mer- 
cury in the breast milk. This method of treating a child 
through the milk of the mother is too uncertain and indefinite 
to be of any practical value. Various other baths, injections, 
and preparations have been from time to time recommended, 
but those mentioned here may be regarded as among the most 
trustworthy. Injections of calomel, peptonate of mercury, and 
oleum cinereum are worthy of mention in addition to the sub- 
limate, which, however, is to be preferred to all others. Fumi- 
gations with calomel and cinnabar are now very little used. 
The value of serotherapy and injections of syphilitic antitoxin 
has not yet been determined sufficiently enough to recommend 
their general use. 

Duration of Treatment. 

No definite time can be stated. Each case differs. Hutchin- 
son continues the treatment only while the clearly apparent 
symptoms are present. Hirschberg employs it through the en- 
tire first year. Holt treats a cachectic child whose parents are 
syphilitic, even though no active symptoms are present. He 
continues treatment for six weeks only, unless symptoms arise. 
Rotch recommends that mercury should be given a syphilitic 
child during the first three or four years of life at intervals of 
three or four months, even if no symptoms arise . He gives 
it at the second dentition and at puberty also. Heubner sug- 
gests that treatment should be continued for fourteen days 
after the last apparent symptoms have disappeared, to be re- 
peated a year later, provided no relapse has occurred in the in- 
terim. Each relapse must be treated in the same way as the 
primary disease. In addition to the general treatment, local 
applications are of the utmost importance. These are the 
same as for adults. The importance of cleanliness, good air, 
and hygienic surroundings cannot be overestimated. 



FORMULARY. 153 

SYPHILIS HEREDITARIA TARDA. 

1. 
Potassii iodidi q. s. 

Give children from the age of six upward, with affections 
of the bones and swelling of the liver and spleen, about fifteen 
grains daily. At puberty, or when the symptoms are espe- 
cially severe, from twenty to thirty grains daily may be given. 

(Heubner.) 



2. 

Iodofornii 10 

Collodii q. s. ad 100. 

Apply locally in cases of periosteal and osteitic gummata 
and joint affections. Tincture of iodine, iodized glycerine, 
and iodol may be used in the form of solutions or ointments. 

(Kaposi.) 



3 

Potassii sive sodii iodidi 75 

Extracti belladonnas foliorum alcoholici. . . , 1 

Aquae destillatae q. s. ad 2000. 

Give from one to two teaspoonfuls three times daily after 
meals. The sodium salt is often better borne than the potas- 
sium. 

4. 
Unguenti hydrargyri q. s. 

Inunctions are to be preferred to all other forms of treatment 
in most forms of the functional nervous disturbances, and par- 
ticularly in the rapid or extensive destruction of the soft parts 
or bones. An inunction of twenty grains may be prescribed 
for children of from eight to twelve years of age, and of thirty- 
five grains for older children. The ointment is rubbed into both 
calves, or both thighs, or both arms, or the entire anterior or 
posterior surface of the trunk. Each cure, therefore, lasts five 
days and is repeated as often as is necessary. Sometimes im- 
provement stops, when it is necessary to cease the medication 
for some weeks and begin anew. Iodine and mercury, either 
in combination or alternately, are indicated in all forms of 

visceral syphilis. 

(Rabl.) 



154 SKIN DISEASES OF CHILDREN. 

General Treatment. 
Everything should be done to strengthen the organism and 
overcome the cachexia, as in the early hereditary syphilis. 
Baths in spring water containing iodine salts, as well as the 
drinking of the water, are often beneficial. Iron also may be 
given. When the cases do not do well under the treatment 
outlined here, Fowler's solution in doses of from five to ten 
drops daily after meals may be given. The Roncegno or 
Levico waters may also be given in doses of from one to two 
teaspoonfuls noon and evening in claret with the meals. Rabl 
gives either of these to children who drink the iodine waters in 
the morning. 

ACQUIRED SYPHILIS IN CHILDREN. 

Every prophylactic measure possible should be taken. 
Nurses and servants should be carefully examined. Drinking 
out of public cups, etc., should be absolutely forbidden, and 
above all indiscriminate kissing. The treatment is the same 
as that of hereditary syphilis. 



URTICARIA. 



1. 
Pilocarpine hydrochloratis q. s. 

Give in distilled water at bedtime from one-twentieth to 
one-eighth of a grain to a child one year old, and from one- 
fifteenth to one-sixth of a grain to a child from two to three 
years old. Gradually increase the dose. 

(Abrahams.) 



Atropinse sulphatis q. s. 

Give one-two-hundred-and-fiftieth of a grain in the form of a 

powder in the evening. 

(Frdntzel.) 

3. 

Atropine sulphatis 1 

Antipyrini q. s. ad 100. 

<Give one-half of a grain of this powder in the evening. 



FORMULARY 155 

4. 

Sodii salicylates q. s. 

Give from five to twenty grains every two hours for three 
doses. Only to be used in severe cases with older children. 

(Lassar.) 

5. 

Calcii chloridi q. s. 

Give in doses of from fifteen to thirty grains three times 
daily. Get the patient under the effects of the drug rapidly, 
and then gradually diminish the dose. 

(Wright.) 

6. 

Sodii chloridi q. s. 

Moisten the affected area with cold water and rub for ten or 
fifteen seconds with ordinary table salt applied to the moistened 
end of the finger. With children, if there is much irritation, a 
little zinc oxide ointment may be afterward applied. 

(Berliner.) 

7. 

Zinci oxidi 50 

Amyli q. s. ad 100. 

Add from one-half to one per cent of finely powdered cam- 
phor to this if the itching is very severe. 

(Gaucher.) 

8. 

Bismuthi salicylates 10 

Amyli q. s. ad 100. 

9. 

Dermatolis 10 

Magnesia? q. s. ad 100. 

10. 

Hydrargy ri chloridi corrosivi 1 

Acidi hydrochlorici 1 

Aquae laurocerasi 100 

Aquae destillatae q. s. ad 2500. 

(Brocq.) 



156 SKIN DISEASES OF CHILDREN. 

11. 

Chloralis 1 

Glycerini 5 

Aquae q. s. ad 100. 

12. 

Glycerini 40 

Balsami Peruviani q. s. ad 100. 

(Monti.) 



13. 

Glycerini 3 

^Etheris 5 

Alcoholis q. s. ad 200. 

14. 

Tincturse benzoini 3 

Mentholis 5 

Glycerini 5 

Alcoholis q. s. ad 200. 

(Kaposi.) 



15. 

Ichthyolis 1 

Petrolati mollis q. s. ad 100. 



1( 



Unguenti hydrargyri ammoniati 20 

Petrolati mollis q. s. ad 100. 

(Holt.) 



17. 

Mentholis 1 

Zinci oxidi 10 

Petrolati mollis. q. s. ad 100. 

18 

Acidi carbolici 1 

Bismuthi subnitratis 10 

Petrolati mollis q. s. ad 100. 

(Gaucher.) 



FORMULARY. 157 

VERRUCA. 

1. 
Acidi nitrici q. s. 

Apply alone on a small piece of wood, or immediately follow 
it by the application of a few drops of pure liquid carbolic acid. 
The latter method is recommended by Laubenberg. 



2. 

Hydrargyri chloridi corrosivi 15 

Alumini 15 

Plumbi carbonatis 15 

Camphorse 15 

Acidi acetici diluti 15 

Alcoholis q. s. ad 100. 

Paint the surface. 

(Plenck ) 



3. 

Glycerini 20 

Acidi acetici glacialis 30 

Sulphuris sublimati q. s. ad 100. 

Apply daily to each wart. Continue treatment for several 
days. Shake well before using. To be used in cases of multi- 
ple warts of the face in older children. 



4. 

Acidi acetici glacialis 8 

Sulphuris sublimati 15 

Glycerini q. s. ad 100. 

To be used in cases in which No. 3 is too strong. 

(Kaposi.) 



5. 

Acidi salicylici 5 

Collodii 15 

^Etheris q. s. ad 100. 

Paint the surface. 

(Shoemaker.) 



158 SKIN DISEASES OF CHILDREN. 

6. 

Acidi salicylici 12 

Collodii ' . .q. s. ad 100. 

Apply twice a day for three days, after which soak the part 

in warm water, and use pumice soap if not inflamed. Repeat 

if necessary. 

(Rotch.) 



ZOSTER 



1. 
Spiritus camphors? q. s 

Give five drops on a lump of sugar three times daily. 

(Drinkwater.) 



2. 

Liquoris potassii arsenitis q. s. 

Give in gradually increasing doses for the neuralgia continu- 
ing after the disappearance of the eruption. If the pain is very 
severe, either morphine, opium, or chloral may be used in older 

children. 

(Kaposi.) 



Salolis 25 

Athens .q. s. ad 100, 



Apply with a brush twice daily. 

(Bilkstein.) 



4. 

Opii pulveris , i 

Camphorae 2 

Zinci oxidi 20 

Amyli q. s. ad 100. 

(Robin.) 



FORMULARY. 159 



a. 



Extracti opii 1 

Cerati 100. 

Not to be used with very young children. 



6. 

Cocainae hydrochloratis 1 

Unguenti q. s. ad 100. 

Not to be used over a large area with very young children. 

(Kaposi.) 



7. 

Acidi carbolici 1 

Mentholis 1 

Unguenti zinci oxidi 50 

Unguenti hydrargyri ammoniati q. s. ad 100. 

Mix and make stiff by adding zinc oxide. Apply thickly on 
a jacket of lint. 

(Taylor.) 



INDEX. 



A. 



Acarus — see scabies, 92 
Achorion, 17 
Acne, treatment, 95 
disseminata, 95 
vulgaris, 95 

treatment— see acne, 95 
Acne varioliformis — see mollus- 

cum contagiosum, 87 
Acquired syphilis in children, treat- 
ment, 154 
Alligator boy, 38 
Alopecia areata, 1 
diagnosis, 2 
etiology, 6 
prognosis, 9 
symptoms, 2 
treatment, 6, 97 
Alopecia areata, plate, 1 
Alopecia circumscripta — see alope- 
cia areata, 1 
Antiseptic cage treatment of burns, 

100 
Antistreptococcic serum treatment 

of erysipelas, 118 
Area Celsi -see alopecia areata, 1 



B. 



Bacillus tuberculosis, 68, 72 
Baldness in contagious impetigo, 24 
Baths in eczema, 49 

in syphilis, 49 
Birthmark, 61 

Bitec of insects, treatment, 99 
Boil, treatment — see furuncle, 123 
Burns, treatment, 100 

powder, treatment, 101 
11 



Chilblains, treatment— 104 
Chloasma, treatment — see freckles 

and other pigmentations, 122 
Chromophytosis, 11 
Claret stain -see nsevus flammeus, 

61 
Clothes louse, treatment— see phthi- 

riasis corporis, 138 
Combustio, treatment - see burns, 

100 
Condyloma subcutaneum— see mol- 

luscum contagiosum, 87 
Congenital ichthyosis, 37 
Contagious impetigo, 21, 46 
diagnosis, 21 
etiology, 21 
prognosis, 25 
symptoms, 21 
treatment, 25, 128 
on the scalp, 24 
Crab louse, treatment — see phthiri- 

asis pubis, 138 
Crusta lactea, 21 
Crusted ringworm — see favus, 121 



D. 



Dental burr in treatment of lupus 

vulgaris, 72 
Dentition, influence of, in etiology 

of eczema, 47 
Dermatitis contusiformis— see ery- 
thema nodosum, 84, 120 
exfoliativa, 28 

exfoliativa neonatorum, treat- 
ment, 106 
gangrenosa, treatment, 105 



162 



INDEX. 



Dermatitis gangrenosa infantum, 
treatment— see dermatitis gan- 
grenosa, 105 

Diffuse congenital keratoma, 37 

Driving in of eczema, 47 

E. 
Ecthyma, 23 
Ectropion in lupus, 70 
Eczema, 41 

etiology, 47 
symptoms, 47 
treatment, 48 
acute, 41 

treatment, 48, 106 
ani, treatment, 113 
aurium, treatment, 113 
capitis, treatment, 114 
chronic, 42 

treatment, 48, 110 
erythematosum, 43 
impetiginosum, 46 
intertrigo— see erythema inter- 
trigo, 43 
treatment, 129 
labiorum, treatment, 116 
narium, treatment, 116 
of the nails, treatment, 134 
palpebrarum, treatment, 117 
papular, 44 
pustular, 46 
rubrum, 46 
squamous, 46 
umbilici, treatment, 117 
Eczema, plate, 41 
Ephelides — see freckles, 122 
Erysipelas, treatment, 118 
Erythema centrifuge — see lupus 

erythematosus, 72 
Erythema, treatment, 119 
intertrigo, 43 

multiforme— see erythema no- 
dosum, 84 
nodosum, 84 

diagnosis, 84 
etiology, 84 
prognosis, 85 
symptoms, 84 
treatment, 85, 120 
pernio, treatment — see chil- 
blains, 104 



Erythematous eczema, 43 

syphilide, 83 
Excessive sweating, treatment- 
see hyperidrosis, 124 



F. 

Favus, 11 

of nails, treatment, 135 
on hairy parts, 15 

diagnosis, 15 

etiology, 17 

prognosis, 19 

prophylaxis, 19 

symptoms, 15 

treatment, 18, 121 
on non-hairy parts, 12 

diagnosis, 12 

etiology, 17 

prognosis, 18 

prophylaxis, 19 

symptoms, 12 

treatment, 18, 121 
Fish-skin disease, 35 
Folliculitis decalvans, 1 
Formulary and note, 95 
Freckles, treatment, 122 
Furuncle, treatment, 123 
Furunculus, treatment— see furun- 
cle, 123 



G. 



Galvano-cauterization treatment of 

furuncle, 124 
Guttate form of psoriasis, 27 



H. 



Harlequin foetus, 37 

Head louse, treatment— see phthiri- 

asis capitis, 137 
Hemorrhage, idiopathic, 85 
Hereditary syphilis, 83 
Herpes esthiomenos — see lupus, 67 

tonsurans— see ringworm upon 
hairy parts, 13 

zoster, treatment— see zoster, 158 
Hives, treatment— see zoster, 158 
Honeycomb ringworm — see favus, 11 
Hyperidrosis, treatment, 124 



INDEX, 



163 



Ichthyose — see ichthyosis, 35 
Ichthyosis, 35 

diagnosis, 35 
etiology, 40 
prognosis, 35 
symptoms, 35 
treatment, 40 
congenita, 37 
hystrix, 37, 51 

linearis neuropathica localis, 51 
mitis, 35 
simplex, 35 

vera — see ichthyosis, 35 
Ichthyosis, plate, 35 
Idiopathic hemorrhage, 85 
Idrosis, treatment — see hyperidro- 

sis, 124 
Ignis sacer. treatment — see zoster, 158 
Impetigo — see contagious impeti- 
go, 21 
treatment, 25, 128 
contagiosa— see contagious im- 
petigo, 21 
Impetigo contagiosa, plate, 21 
Infantile syphilis, hereditary, 83 
Intertrigo, treatment, 129 
Itch, treatment— see scabies, 92 

K. 

Kelis — see keloid, 90 
Keloid, 90 

diagnosis, 91 

etiology, 90 

prognosis, 92 

symptoms, 90 

treatment, 92 
false, 90 
true, 90 
Keratosis follicularis, 89 

diagnosis, 89 

etiology, 89 

prognosis, 90 

symptoms, 89 

treatment, 90 
follicularis, Darier, 90 
pilaris, 89 

L. 
Lentigo, treatment— see freckles, 122 
Lice, treatment— see phthiriasis, 137 



Lichen pilaris, 89 
planus, 80, 83 
diagnosis, 80 
prognosis, 82 
symptoms, 80 
treatment, 82 
Lichen ruber, 75 

diagnosis, 75 
prognosis, 79 
symptoms, 75 
treatment, 80 
forms of: 
papular, 78 
rugous, 79 
squamous, 78 
Lichen ruber, plate, 75 
Lichen simplex— see papular ecze- 
ma, 44 
tropicus, treatment — see mili- 
aria, 133 
Linear papilloma— see papilloma 

lineare, 61 
London hospital treatment of burns, 

100 
Lupus, 67 

diagnosis, 68 
etiology, 67 
symptoms, 68 
treatment, 72, 130 
and other tuberculides, 67 
erythematodes— see lupus ery- 
thematosus, 72 
erythematosus, 72 

treatment, 72, 132 
superricialis — see lupus erythe- 
matosus 72 
verrucosus— see tuberculosis ver- 
rucosa, 70 
vulgaris — see lupus, 67 
Lupus vulgaris, plate, 67 

M. 

Miliaria, treatment, 133 
alba, 
rubra, 

treatment— see miliaria 133 
Molluscum, 87 

contagiosum, 87 
diagnosis, 89 
etiology, 88 



16± 



INDEX. 



Molluscum contagiosum, prognosis, 
89 
symptoms, 87 
treatment, 89 
fibrosum, 87 
sebaceum, 87 
Morbus pedicularis, treatment — see 
phthisiasis, 137 

N. 

Naevi, pigmented and hairy, 55 
Naevus araneus, 61 

treatment, 64, 134 
cavernosus, 61, 63 

treatment, 64, 134 
flammeus, 61 

treatment, 64, 134 
pigmentosus, 55 

treatment, 57 
pilosus. 55 

treatment, 58 
sanguineus - see vascular nae- 

vus, 61 
Juberosus, 61, 62 

treatment, 65, 134 
unius lateris, 51, 52 
vascularis — see vascular nsevus, 

61 
verrucosus, 37, 51 
Naevus pilosus, plate, 55 
Nails, diseases of, treatment : 
eczema, 134 
favus, 135 
psoriasis, 135 
ringworm, 135, 136 
Nerve naevus — see papilloma lineare, 

51 
Nettle rash, treatment — see urtica- 
ria, 154 

O. 

Onychomycosis favosa, treatment — 
see favus of the nails, 135 
trichophy tina , treatment —see 
ringworm of the nails, 136 

P. 

Papilloma lineare, 51 
diagnosis, 51 
symptoms, 51 
treatment, 53 



Papilloma lineare, plate, 51 

neuroticum — see papilloma line- 
are, 51 
Papular eczema, 44 
eyphilide, 30, 83 
Parchment skin, 35 
Paronychia, in contagious impetigo, 

25 
Pediculosis, treatment: 
capitis, 137 
corporis, 137 
pubis, 136 
see phthiriasis. 137 
Pediculus vestimentorum, treat- 
ment—see phthiriasis corporis, 
138 
Peliosis rheumatica, 87 
Pemphigus gangraenosus, treat- 
ment — see dermatitis gangraeno- 
sa, 105 
Pernio, treatment — see chilblains, 

104 
Phtheiriasis, treatment — see phthiri- 
asis, 137 
Phthiriasis, treatment: 
capitis, 137 
corporis, 138 
pubis, 138 
Pigmentary naevus, 55 
Pityriasis, 43 

pilaris — see keratosis follicula- 

ris, 89 
rubra pilaris, 75 
Porcupine skin, 37 
Porrigo contagiosa — see contagious 
impetigo, §1 
decalvans — see alopecia areata, 

1 
furfurans — see ringworm upon 
hairy parts, 13 
Port wine mark, 61 
Powder burns, treatment, 101 
Prickly heat, treatment — see mili- 
aria, 133 
Prurigo, treatment, 139 
Pruritus cutaneus, treatment, 140 
Psoriasis, 27 

diagnosis, 27 
etiology, 32 
prognosis, 32 
symptoms, 27 



INDEX 



165 



Psoriasis, treatment, 32, 141 
forms of : 
guttate, 27 
nummular, 27 
punctate, 27 

of the nails, treatment, 135 
Psoriasis, plate, 27 
Purpura, 85 

diagnosis, 87 
etiology, 85 
prognosis, 86 
symptoms, 85 
treatment, 87 
hemorrhagica, 86 
papulosa, 86 
rheumatica, 87 
treatment, 142 
Pus cocci, in contagious impetigo, 

21 
Pustular eczema, 21 

Q. 

Quinine, in erythema nodosum, 120 
R. 

Ringworm and favus, 11 
Ringworm of thenails,treatment,136 
of the scalp — see ringworm 

upon hairy parts, 13 
upon hairy j}arts, 13 

diagnosis, 13 

etiology, 17 

prognosis, 19 

prophylaxis, 19 

symptoms, 13 

treatment, 17, 143 
upon non-hairy parts, 12 

diagnosis, 12 

etiology, 17 

prognosis, 18 

prophylaxis, 19 

symptoms, 12 

treatment, 18 

S. 
Scabies, 92 

diagnosis, 92 
etiology, 92 
prognosis, 93 
symptoms, 92 
treatment, 93, 144 



Scrofulide erythemateuse— see lu- 
pus erythematosus, 72 
tuberculeuse— see lupus, 67 
Scrofuloderma, 71 
Seborrhoea, balanitis and posthitis, 
treatment, 148 
capitis, treatment, 146 
squamosa neonatorum, treat- 
ment, 147 
Shingles, treatment— see zoster, 158 
Stings of insects, treatment, 99 
Strumous dactylitis. 71 
Sudamina, treatment— see miliaria, 

133 
Sweating, excessive, treatment— see 

hyperidrosis, 124 
Syphilides, forms of: 
bullous. 83 
erythematous, 83 
papular, 83 
pustular, 83 
Syphilis, acquired, in children, 
treatment, 154 
hereditaria 83 
diagnosis, 83 
symptoms, 83 
treatment, 84, 148 
(a) baths, 150 
(6) duration of, 152 

(c) general, 84 

(d) indirect and other 

methods of, 152 

(e) injections, 150 

(/) internal medica- 
tion, 84, 148 
(g) inunctions, 84, 149 
(h) local, 84, 152 
(i) plasters, 151 
(j) prophylaxis, 83 
Syphilis hereditaria, plate, 83 
Syphilis hereditaria tarda, treat- 
ment, 153 

T. 

Telangiectasis, 61 
Tetter— see eczema, 41 
Tinea circinata— see ringworm up- 
on non-hairy parts, 12 
decalvans— see alopecia areata, 

1 
favosa — see favus, 11 



166 



INDEX, 



Tinea favosa unguium, treatment — 
see favus of the nails, 135 
furfuracea, treatment — see se- 

borrhoea, 146 
kerion — see kerion, 14 
lupinosa — see favus, 11 
tonsurans— see ringworm upon 

hairy parts, 13 
trichophytina — see ringworm, 

11 
trichophytina unguium, treat- 
ment — see ringworm of the 
nails, 136 
versicolor, 11 
Treatment of powder burns, 101 
Trichophyton, 17 
Trichophytosis, 11 
Trichophytosis capitis, plate, 11 
Tuberculides, lupus and other, 67 
Tuberculosis bacillus, in lupus. 68 

in lupus erythematosus, 72 
Tuberculosis verrucosa, 70 

U. 

Ulcers, of conjunctiva and buccal 
mucous membrane, in impetigo, 
25 

Urticaria, treatment, 154 



V. 

Vaccination, double infection with, 

24 
Vaccine-lymph treatment of neevus 

vasculosus, 134 
Varicella gangrenosa, treatment— 

see dermatitis gangrenosa, 105 
Various skin diseases of children, 

83 
Vascular nsevus, 61 
Vascular nevus, plate, 61 
Vegetable parasites, 11 
Verruca, 51 

treatment, 157 

W. 
Warts, 51 

treatment — see verruce, 157 
Water-bed treatment of burns, 101 

X. 

Xeroderma, 35 

ichthyoides — see ichthyosis, 35 

Z. 

Zona, treatment — see zoster, 158 
Zoster, treatment, 158 



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Sachs, B., n.D., 

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